A career in pathology

A career in

Pathology Your guide to a career in pathology

Contents What is pathology?

What is a pathologist?

Career opportunities How do I become a pathologist?

Anatomical pathology A career in perinatal pathology Chemical pathology Forensic pathology General pathology Genetic pathology Haematology Immunopathology Microbiology Useful resources and links

2

RCPA Career Guide

4 6 7 8 12 16 20 22 26 28 30 34 36 40

Foreword A career in pathology – what it takes to become a doctor’s doctor “As is our pathology so is our practice…what the pathologist thinks today, the physician does tomorrow.”

Sir William Osler, a founding professor of Johns Hopkins University The decision to pursue a career in medicine is borne from an intrinsic desire to help others – our patients – and there is no other medical discipline that allows a single practitioner to make a difference to as many patients as a career in pathology does.

As a career, pathology is extremely fulfilling. What happens at the laboratory bench is as critical to patient care as what happens at the bedside. It’s an intellectual quest to delve into the very heart of medicine across a choice of disciplines, to contribute to the diagnosis and management of every patient, and to help solve the medical conundrums that make a fundamental difference in the lives of our patients.

The opportunities in pathology are immense to suit you, your personality and your lifestyle: from public hospital pathology, the private sector, research and academia to a career in informatics and technology or management, all ultimately working to improve healthcare for all.

If you are compassionate, love science and are curious about finding solutions to medical problems, I would urge you to consider a career in pathology.

I trust this guide will provide some useful insights into the opportunities available to you as a specialist pathologist, and I very much hope to welcome you to our community at the RCPA.

Associate Professor Trishe Leong RCPA President

< Back to contents

3

What is pathology?

Pathology is the medical specialty concerned with the study of the nature and causes of diseases. It underpins every aspect of medicine, from diagnostic testing and monitoring of chronic diseases to cuttingedge genetic research and blood transfusion technologies. Pathology is integral to the diagnosis of every cancer.

Timely and accurate pathology results are critical to the functioning of our entire healthcare system. Pathology plays a vital role across all facets of medicine throughout our lives, from pre-conception to postmortem.

There are 8 key disciplines of pathology

Anatomical pathology

Chemical pathology

Forensic pathology

General pathology

Haematology

Immunpathology

Microbiology

Genetic pathology

Genetic pathology

What you need to become a pathologist

Compassion Curiosity Science 4

RCPA Career Guide

Pathology is integral to the diagnosis of every cancer.

Role of the Royal College of Pathologists of Australasia The Royal College of Pathologists of Australasia (RCPA) oversees Fellowship programs for Trainees. These are usually completed over a minimum of five years (full-time equivalent), with training undertaken in accredited laboratories in pathology in one of these disciplines. The disciplines, including the training pathway for each, are discussed in detail in this guide.

The RCPA supports the timely adoption of appropriate new tests and is committed to ongoing education, research and teaching.

The RCPA is also home to four faculties: • Faculty of Clinical Forensic Medicine • Faculty of Oral and Maxillofacial Pathology • Faculty of Science • Faculty of Postmortem Imaging (training program being developed) < Back to contents

5

What is a pathologist?

Pathologists are doctors. They are specialist medical practitioners who study the cause of disease and the ways in which diseases affect our bodies by examining changes in tissues and other body fluids. This may show the potential to develop a disease, or show its presence, cause or severity, or monitor its progress or the effects of treatment.

When a general practitioner arranges a blood test or a surgeon wants to know the nature of a lump that has been surgically removed, the definitive answer is usually provided based on the knowledge, diagnostic skills and advice of pathologists. Some pathologists also see patients and are involved directly in the day-to-day delivery of patient care.

Find out more

6

RCPA Career Guide

Career opportunities Pathology technology

Research

Private pathology

Public pathology Teaching

Management

Pathology informatics

< Back to contents

7

How do I become a pathologist?

It takes approximately 13 years to qualify as a pathologist.

You must first train to become a medical doctor. You then need to undertake at least two years (full-time equivalent) of postgraduate clinical medicine after which you can apply to train as a pathologist in one of the eight disciplines of pathology. This training involves at least five years (full-time equivalent) of certified training in an accredited pathology laboratory as well as the completion of a number of examinations and assessments.

Exam timeline Basic pathological sciences (BPS) examination

Part I examination

Part II examination

The BPS examination may be taken before training commences. The examination is open to RCPA Trainees, prevocational doctors, and students of medicine, dentistry and science. It must be completed before you sit your Part II examination.

This is usually taken in the third year of training.

This is usually taken in the fifth or final year of training.

How to apply to train to be a pathologist Applicants need to be employed in an accredited site before registering for training with the RCPA. The College plays no part in placing applicants in employment. You have to train in at least two sites for a minimum of five years. You can only spend a maximum of four years in one laboratory.

Entry to training programs is competitive with most states and territories calling for applications in June/July for training commencing in the following year. Your application may be strengthened by having successfully completed the BPS examination. Any doctors interested in learning more about pathology should try to organise a visit to a local laboratory.

View Guidelines for the Selection of Trainees 8

RCPA Career Guide

Accredited training laboratories The RCPA accredits laboratories for pathology training, approves supervised training undertaken in an accredited laboratory and conducts examinations leading to Fellowship.

Laboratories are accredited for pathology training in Australia, New Zealand, Hong Kong, Malaysia, Saudi Arabia and Singapore.

Is pathology right for me?

As a pathologist, you will see a wide variety of interesting and challenging cases. The work frequently involves laboratory and clinical medicine, and most pathologists work with a range of medical specialists, including general practitioners, surgeons and physicans. You will also have opportunities to carry out research.

Apply for Fellowship Once you have completed all the training requirements successfully, you can apply to become a Fellow of the Royal College of Pathologists of Australasia (RCPA) and hold the title FRCPA.

Find out more

Research and scholarship requirements All disciplines have research assessment requirements. These vary from discipline to discipline. Find out more in the RCPA Curriculum/Training Handbooks.

Training options Single discipline training You can choose to become a pathologist in a single discipline in anatomical pathology, chemical pathology, general pathology, genetic pathology, forensic pathology, haematology, immunopathology or microbiology.

Joint training The RCPA training program is linked to training programs of the Royal Australasian College of Physicians (RACP) in chemical pathology, haematology, immunopathology and microbiology.

If you choose to undertake these disciplines, you may choose to undertake joint training and attain Fellowships of both Colleges.

The joint training scheme between the RCPA and the RACP is available in:

• • • •

Chemical pathology/endocrinology Haematology/clinical haematology Immunology and allergy Microbiology/infectious diseases.

A reciprocal training program is available for genetic pathology and clinical genetics in conjunction with the RACP.

< Back to contents

9

The journey to become a pathologist...

Complete medical degree

Complete two years of clinical training

Consider a pathology rotation

Choose a pathology discipline

Anatomical Chemical Forensic General Genetic Haematology Immunopathology Microbiology

Apply for a training position in an accredited laboratory

Register with the RCPA

Basic pathological sciences (BPS) examination The BPS examination is a requirement for all Trainees and may be completed before or during training (before completing Part II examinations). You can complete the BPS examination as a medical student for a reduced fee.

10

RCPA Career Guide

Complete training and gain Fellowship

International medical graduates and specialist pathologists If you are an overseas trained pathologist (meaning you have obtained specialist pathology qualifications outside of Australia) and would like to work as a pathologist in Australia, you may have to undertake further training.

Find out about what you need to do before you can work as a pathologist in Australia The process may be different for Australian medical graduates who have obtained specialist pathology qualifications overseas.

International medical graduates (that is, those who are not yet specialist pathologists in their country of origin) who wish to work in Australia and undertake pathology training will need to follow the Standard pathway.

RCPA has developed a series of step-by-step guides to explain what you need to do to fulfill your obligations under the rules set out by the Medical Board of Australia and train with the RCPA.

If you are an overseas trained pathologist residing and working as a pathologist in a country where the RCPA has a training program (New Zealand, Hong Kong, Malaysia, Saudi Arabia and Singapore), a different application process applies.

< Back to contents

11

Anatomical pathology

12

RCPA Career Guide

What does an anatomical pathologist do?

Professional scope and opportunities

Anatomical pathologists are medical specialists who examine organs, tissues and cells to determine the causes and effects of the disease. The anatomical pathologist’s skills are fundamental to medical diagnosis, patient management and research.

The range of cases in a pathologist’s daily workload can be broad or narrowed to particular specialties. For example, on any given day, an anatomical pathologist could review skin biopsies, cervical specimens, or they may investigate why a patient’s body is rejecting a newly transplanted organ. In private practice, a pathologist may choose to specialise in, for example, gynaecological pathology or dermatopathology. Hospital-based anatomical pathologists may be involved in intraoperative diagnoses and urgent diagnostic biopsies from critically ill patients.

The work of an anatomical pathologist includes cytology and histology. Cytology refers to the structure and function of individual cells. These cells (eg, cervical cells) are aspirated or obtained from body tissues and examined with a microscope. Histopathology is the examination of tissues, taken either as biopsy samples or resection specimens. A tissue diagnosis is essential before treatment, which could include surgery, medications and radiation.

Anatomical pathologists need a keen eye for detail as well as a broad-based knowledge and understanding of the pathological and clinical aspects of many diseases.

Anatomical pathology is one of the few branches of medicine that constantly evolve to incorporate new advances in medical science, whether that be molecular diagnostics in various diseases or the use of artificial intelligence to improve diagnostic accuracy.

The speciality of anatomical pathology also provides extensive opportunities for research, which can easily be part of daily work.

A scientific career in problem solving Anatomical pathology is the scientific foundation of all medicine. It can answer important research questions, and an anatomical pathologist could be considered the doctor’s doctor, regularly liaising with many other specialists. A diagnosis from the pathologist may guide the surgeon’s hand, the oncologist’s course of treatment or a GP to their next course of action.

If you have an inquisitive mind, an urge for problemsolving, attention to detail and are interested in the root cause of disease and how diseases evolve, then anatomical pathology may be a career for you.

Did you know?

Viruses can cause certain types of cancers and their presence in tumour cells can change treatment.

< Back to contents

13

If you have an inquisitive mind, an urge for problem-solving, attention to detail and are interested in the root cause of disease and how diseases evolve, then anatomical pathology may be a career for you.

Training pathway To become an anatomical pathologist, first complete your medical degree and at least two postgraduate clinical years. You may choose to undertake the basic pathological sciences (BPS) examination during this time.

This exam is a requirement for all Trainees and may be completed before or during training (before completing Part II examinations). You can complete the BPS examination as a medical student for a reduced fee.

“A large part of my role is the detection and diagnosis of cancer.”

Dr Adrienne Morey

Specialist single-discipline pathology training The training time for specialist single-discipline pathology training is typically five years in a registrar position accredited by the RCPA. During this time, the registrar (Trainee) learns how to examine surgical and cytology specimens and how to use ancillary techniques such as immunohistochemistry and molecular pathology.

Presentation at clinical meetings and participation in research also form a component of the training.

Further subspecialty training You may choose to undertake further subspecialty training in areas such as dermatopathology, paediatric and gynaecological pathology, or perinatal pathology (see page 16). The RCPA also offers post-fellowship certificates in forensic pathology.

Day in the life of an anatomical pathologist

14

RCPA Career Guide

Why I chose anatomical pathology “When I was a kid, I enjoyed puzzles and solving mysteries and my favourite book was ‘Where’s Wally?’ As an anatomical pathologist, you investigate diagnostic dilemmas by reviewing cells, tissues and even whole organs under the microscope. A true medical detective, it is incredibly fascinating.”

Dr Ivan Canoy < Back to contents

15

A career in perinatal pathology

Doctor/medical student

Complete two years of clinical training

Become an anatomical pathologist

Become a perinatal pathologist

Work in a perinatal services unit

16

RCPA Career Guide

What is perinatal pathology?

Perinatal death is defined as the death of an intact baby in utero weighing 400 grams or more birthweight or the neonatal death of a live born baby within 28 days of birth. An anatomical pathologist specialising in perinatal pathology uses the information provided on postmortem examination and associated pathological investigations (eg, histopathology, genetics, microbiology, immunopathology) along with selected radiological investigations and multidisciplinary team expertise to establish the mostly likely cause of death.

Did you know?

175,000 people are being affected every year by a perinatal death.

What does a perinatal investigation involve?

The following core/traditional investigations are recommended in all cases of perinatal death where consent has been obtained:

• • • • • •

•

Maternal, family and antenatal history Delivery history Review of radiology (antenatal screening) Review of antenatal investigations Clinical photographs Radiological examinations such as magnetic resonance imaging (MRI), X-rays, computed tomography (CT) or ultrasound examination (US), as indicated External/physical examination, including correlation with published parameters expected for gestational age

•

• •

Internal examination assessing the normal or abnormal anatomy, as well as the structure and weights of all organs, including expected weights for gestational age Placenta and umbilical cord examination DNA extraction, storage and single nucleotide polymorphism (SNP) microarray.

Ancillary investigations may include: • Targeted genetic panels • +/- Microbiology studies/infection control • +/- Metabolic studies • Other investigations as per the clinical presentation, and consultation with clinicians and a geneticist.

< Back to contents

17

“Perinatal pathology is an area of medicine where we’re trying to give answers to women, their families, and the treating team when there’s been an adverse outcome of a pregnancy, including stillbirth.”

Professor Jane Dahlstrom OAM

What are required personal What training is required? characteristics to undertake First, you must be a qualified registered medical practitioner with a minimum of two years postgraduate perinatal investigations? experience. In addition, you must pass or be exempt In addition to the skill set required to be an anatomical pathologist, the following personal characteristics are important:

• •

•

An enquiring mind. Many cases you’ll encounter will be very rare and will need additional reading and research.

A sensitive approach to communication.

On occasion, you may need to meet bereaved families to discuss postmortem findings and their implications.

Meticulous attention to detail. You’ll need to be able to spot small and complex changes in human tissue.

What are the rewards of perinatal pathology as a career choice?

• • •

18

Belonging to a small speciality Interesting and challenging cases Finding the answers not only provides closure for families, but also helps families and healthcare professionals reduce the risk of subsequent perinatal deaths, target counselling for heritable disorders, and guide clinical care for maternal or environmental factors in future pregnancies.

RCPA Career Guide

from the basic pathological sciences examination which may be taken before commencement of training.

It is open to any intern, medical or dental student in their final year as well as registered trainees, usually in the first year of training.

The minimum time for specialist training as an anatomical pathologist is five years in a registrar position accredited by the Royal College of Pathologists of Australasia (RCPA). Anatomical pathology registrars are trained in the examination of surgical, frozen sections, and cytology specimens. Refer to the Trainee Handbook for essential training information.

Once you are an anatomical pathologist you can then train as a specialist in perinatal pathology. This will require 12 months full-time equivalent experience in a laboratory approved by the RCPA for training in paediatric and perinatal pathology.

The RCPA will offer a Certificate in Autopsy (Perinatal subspecialty), and a Post-Fellowship Certificate in Perinatal Pathology or a combined Perinatal/ Paediatric Pathology Post-Fellowship Certificate; however, completion of these is a voluntary commitment.

< Back to contents

19

Chemical pathology

20

RCPA Career Guide

What does a chemical pathologist do?

Chemical pathologists are medical doctors who study, diagnose and aid in managing the vast range of diseases that require biochemical testing for diagnosis and management.

They integrate laboratory science with clinical medicine by examining blood and other body fluids to look for changes to a patient’s biochemistry, such as in salts, fats, sugars and proteins. Chemical pathologists also focus on measuring and interpreting cancer markers, hormones and poisons. In addition, these specialists study toxicology to investigate levels of therapeutic and illicit drugs. Given how broad these investigations and related diseases are, it is easy to see how no two days are alike for a chemical pathologist.

Professional scope and opportunities Chemical pathologists regularly consult with other medical practitioners to advise on appropriate test selection, result interpretation and follow-up. When a chemical pathologist interprets results, they must consider many factors, such as the patient’s gender, age, existing conditions and symptoms. These considerations may mean the same result for two different patients doesn’t automatically result in the same diagnosis. This work requires a high level of expertise to ensure the best guidance for the referring doctor and their patient.

As this speciality covers a diverse range of investigations and subspecialties, the role and career path of the chemical pathologist can be highly individual, depending on your interests. With access to vast volumes of test result data, chemical pathologists can and often participate in a wide range of research and audit opportunities and contribute to key clinical guidelines.

The modern laboratory is highly automated. The increasing use of sophisticated, intelligent systems under the command of chemical pathologists enables them to ensure the accurate reporting, communication and interpretation of large numbers of laboratory tests.

Day in the life of a chemical pathologist

Training pathway To become a chemical pathologist, complete your medical degree and at least two postgraduate clinical years. You may choose to undertake the basic pathological sciences (BPS) examination during this time.

This exam is a requirement for all Trainees and may be completed before or during training (before completing Part II examinations). You can complete the BPS examination as a medical student for a reduced fee.

Specialist single-discipline pathology training The training time for specialist single-discipline pathology training is typically five years in a training position accredited by the RCPA. During this time, a registrar trains in the field of chemical pathology.

Joint training options with the Royal Australasian College of Physicians (RACP) You may elect to undertake laboratory and clinical training and apply for joint training with the RCPA and the Royal Australasian College of Physicians (RACP) in endocrinology/chemical pathology.

Did you know?

A modern pregnancy test detects the levels of hCG (human chorionic gondatropin) in urine. But, in the past, the standard test involved the use of cane toads.

In Australia, male cane toads were injected with a solution, containing the patient’s urine. If the cane toad increased its sperm production after this procedure, it was considered a positive test!

< Back to contents

21

Forensic pathology

Day in the life of a forensic pathologist

22

RCPA Career Guide

What does a forensic pathologist do?

Forensic pathologists are medical doctors who work principally with the justice system and play a vital role in the work of the criminal and coroners courts. Forensic pathologists undertake medico-legal investigations of sudden or unexpected death in partnership with the police and other investigative agencies. They assist investigators in determining the medical cause of death and, importantly, reconstructing the circumstances surrounding the infliction of injuries and fatalities.

Forensic pathologists provide coroners with the medical and pathology evidence needed for the coroner to determine the identification of the deceased and how, when and where the person died. Forensic pathologists use a variety of medical investigations that include analysis of tissue, body fluids and dissection procedures (postmortem examinations) and, more recently, postmortem imaging, all of which provide critical information to assist in determining how the death occurred. Many of the deaths investigated by forensic pathologists are a result of natural disease and, therefore, forensic pathologists need to have a thorough knowledge of many of the subdisciplines of pathology, including anatomical pathology, haematology, microbiology, chemical pathology, immunopathology and cytogenetics.

The outcome of a medico-legal death investigation may also have health ramifications for the family and the greater community. Contrary to popular belief, forensic pathologists do not limit their scope of work with only the deceased. As medical practitioners, they work closely with their clinical colleagues and must remain alert to the possibility that the cause of death may have implications for the health of members of the deceased’s family. The discovery of diseases in a deceased person that may have a genetic link could provide living relatives with vital information to make informed choices regarding their health and welfare.

Forensic pathologists also have a public health role to help identify patterns and trends in deaths and injuries leading to changes in government policy, including public health policy and services that are designed to support community health and welfare and prevent avoidable death and injury.

While forensic pathology is intellectually stimulating, it also involves ongoing exposure to emotionally challenging scenarios involving deaths from accidents, disasters and human violence. Dealing with grieving families and engaging with an often highly adversarial legal system can be stressful, making forensic pathology a career that requires practitioners to establish a supportive work-life balance.

Training pathway To become a forensic pathologist, complete your medical degree and at least two postgraduate clinical years. You may choose to undertake the basic pathological sciences (BPS) examination during this time.

This exam is a requirement for all Trainees and may be completed before or during training (before completing Part II examinations). You can complete the BPS examination as a medical student for a reduced fee.

Forensic pathology training pathways There are three different ways to train as a forensic pathologist:

•

Train for five years in forensic pathology. This includes 18 months of training in anatomical pathology.

•

Complete Part I of the RCPA anatomical pathology examination and then continue your training in forensic pathology.

•

Complete your training in anatomical pathology and then complete a Post-Fellowship Certificate in forensic pathology.

Specialist single-discipline pathology training The training time for specialist single-discipline pathology training is typically five years in a training position accredited by the RCPA. During this time, a registrar trains in the field of forensic pathology, which includes performing postmortem examinations and examining tissue samples.

Did you know?

Forensic pathologists play an active role in victim identification. Australian forensic pathologists were involved in providing valuable insights in the aftermath of the Bali bombings, the Boxing Day tsunami, the Black Saturday bushfires, the loss of Malaysian Airways Flight MH17 and a variety of other transport and terrorismrelated deaths.

< Back to contents

23

Why I chose chemical pathology “I enjoy the problem-solving involved with chemical pathology. It is a rewarding kind of problem-solving to arrive at a diagnosis and make a difference for patients.”

Dr Paul Bonnitcha

24

RCPA Career Guide

Why I chose forensic pathology “While we almost exclusively deal with deceased patients, forensic pathologists can provide answers for the living. I have been involved with many autopsies that uncovered a genetic cause of death. Ironically, these examinations can save the lives of their living relatives.

It is an interesting and rewarding career, and I’d strongly encourage anyone interested in forensic pathology to pursue it.”

Dr Jack Garland

< Back to contents

25

General pathology

26

RCPA Career Guide

What does a general pathologist do?

General pathology involves all aspects of pathology. It deals with the diagnosis and management of disease using every component of laboratory medicine and every diagnostic technique. General pathologists have a broad understanding of the pathophysiology of disease, the diagnostic value of individual tests and also of the laboratory and its workings.

General pathologists need to be familiar with the theoretical basis of investigation and the scientific principles of anatomical, biochemical and physiological processes of the healthy human body and the mechanisms that fail during disease. They also need to have knowledge and experience of the limits of investigative processes, the pitfalls in measurements and the interpretation of diagnostic techniques.

Training pathway To become a general pathologist, you need to first complete your medical degree and at least two postgraduate clinical years. You may choose to undertake the basic pathological sciences (BPS) examination during this time. This exam is a requirement for all Trainees and may be completed before or during training (before completing all examinations). You can complete the BPS examination as a medical student for a reduced fee.

The general pathology program requires successful completion of the BPS followed by eight months of training and the successful completion of examinations in each of the disciplines of chemical pathology, haematology and microbiology. Knowledge of immunopathology and genetic pathology is also required before completion of a clinical consolidation oral examination. Twenty-four months of training, and written and oral examinations in anatomical pathology, including cytology, complete the program.

General pathologists are often responsible for managing laboratories, ensuring the quality of the results and providing a diagnostic service and advice to clinicians.

They use their expertise in offering expert opinion to clinicians about the choice of biopsy/specimen, taking into account the clinical setting and its limitations in the interpretation of results.

Professional scope and opportunities General pathologists may work as a supervising pathologist in a small area hospital or branch laboratory.

They may share duties with other general or specialist pathologists in a district hospital or medium-sized pathology practice.

They may also work in a teaching hospital either as a general pathologist in one or more departments or as head of a department.

Did you know?

The first known pathology test was for diabetes. If ants were attracted to a patient’s urine, diabetes would be diagnosed.

< Back to contents

27

Genetic pathology

Day in the life of a genetic pathologist

28

RCPA Career Guide

What does a genetic pathologist do?

Genetic pathologists are medical specialists with expertise in the genetic basis of disease. Daily activities can include analysing, interpreting and integrating genomic data within a clinical context. It also involves writing and reviewing diagnostic patient reports, and communicating with clinicians about clinically important or complex results. Genetic pathologists are responsible for the overall supervision of the laboratory, particularly in relation to patient safety and the quality of the genetic testing provided.

Genetic pathology is a relatively new discipline in pathology that uses the genetic code to provide answers for patients and their families. This rapidly expanding field is continuously reshaping clinical practice, changing the way illnesses are diagnosed, treated, monitored and prevented.

Genetic results help patients and their families in many ways, including:

•

Diagnosis of inherited disorders. Making a diagnosis in someone with features suggestive of a genetic condition (eg, providing answers for a family with a sick child).

•

Predictive testing for inherited disorders.

Enabling asymptomatic family members to find out whether they are at risk of developing a genetic condition that runs in their family. If at risk, prophylactic measures or early treatment may prevent disease or reduce its severity.

•

Reproductive carrier screening. Identifying individuals and couples at risk of having a child with a serious genetic disorder to guide reproductive options and increase the chances of having a healthy baby.

•

Cancer precision medicine. Enabling patients to access specific treatments that best match the genetic variants driving their cancer diagnosis.

This speciality offers a role at the forefront of science, while having direct impact on patient care through the provision of clinically useful laboratory testing. As genomic knowledge and technology move forward, genetic pathologists are continually looking to harness this information to improve individual and population health. This includes developing and implementing new tests and promoting awareness and advocating for funding to enable universal and safe access to genetic tests. Genetic pathologists work in close collaboration with medical scientists and consult widely with other pathologists, medical specialists, general practitioners and genetic counsellors.

Training pathway To become a genetic pathologist, complete your medical degree and at least two postgraduate clinical years.

You may choose to undertake the basic pathological sciences (BPS) examination during this time. This exam is a requirement for all Trainees and may be completed before or during training (before completing Part II examinations). You can complete the BPS examination as a medical student for a reduced fee.

Specialist single-discipline pathology training The training time for specialist single-discipline pathology training is typically five years in a training position accredited by the RCPA. During this time, a registrar trains in the rapidly expanding field of genetic pathology and gains experience in a broad range of genetic-based technologies including cytogenetics and molecular pathology. Specialisations are offered in medical genomics and biochemical genetics.

Genetic pathology reciprocal training option You may elect to undertake reciprocal training with the RCPA and the Royal Australasian College of Physicians (RACP) in clinical genetics/medical genomics. This program leads to the award of two Fellowships.

Did you know?

Most people are carriers for at least one genetic condition.

< Back to contents

29

Haematology

30

RCPA Career Guide

What does a haematologist do?

Haematologists are medical doctors who specialise in diseases affecting the blood such as anaemia, leukaemia, lymphoma, clotting or bleeding disorders as well as the management of blood transfusions. In many illnesses, the blood system responds or contributes to the condition; however, occasionally, it is directly responsible for causing disease.

A haematologist develops specialised skills in the laboratory, including blood cell and bone marrow morphology, investigation of haemoglobinopathies, haemostasis and thrombosis. Haematologists also investigate and diagnose blood cancers, such as leukaemias and lymphomas, and have a detailed knowledge of transfusion medicine. Haematologists can also be directly involved in patient care in the clinical setting and this diversity and variety is a significant attraction to the specialty.

Haematologists may perform bone marrow biopsies and analyse the specimens to diagnose and manage bone marrow disorders. This may involve consideration of ancillary testing such as cytogenetic or molecular analysis. They investigate and treat bleeding and clotting disorders and manage and monitor blood-thinning medications. Haematologists oversee the transfusion of blood products, providing advice about the appropriate management of massive transfusion episodes. They manage genetic blood disorders such as thalassemia and malignant conditions such as myeloma.

Haematologists harness their skills to interpret abnormalities in test results and consult with other medical practitioners, guiding appropriate patient care or further investigations. Some haematologists are involved with blood banks that support the need for blood products in hospitals. Transfusions may be required for surgery, such as after road trauma or with acute bleeding, which can occur after childbirth.

The specialty of haematology provides many research opportunities that can directly impact patient care.

Translational research in this area has led to a cure for chronic myeloid leukaemia and has also revolutionised marrow and haemopoietic progenitor cell transplants, saving many lives.

Training pathway To become a haematologist, you need to first complete your medical degree and at least two postgraduate clinical years. You may choose to undertake the basic pathological sciences (BPS) examination during this time.

This exam is a requirement for all Trainees and may be completed before or during training (before completing Part II examinations). You can complete the BPS examination as a medical student for a reduced fee.

Specialist single-discipline pathology training The minimum time for single-discipline specialist pathologist training in haematology is five years in a registrar position accredited by the RCPA. During this time, a registrar trains in the dynamic field of laboratory haematology and transfusion.

Haematology joint training options You may elect to undertake both laboratory haematology and clinical haematology training and apply for joint training with the RCPA and the Royal Australasian College of Physicians (RACP).

Did you know?

The human body manufactures 17 million red blood cells per second.

Day in the life of a haematologist

< Back to contents

31

Why I chose genetic pathology “I enjoy the cutting-edge nature of genetics, the mix of independent and teamwork, and the opportunity to make a difference to not only the patient but also the family.”

Dr Samantha Sundercombe

32

RCPA Career Guide

Why I chose haematology “Training to become a haematologist is endlessly stimulating. We learn skills that enable us to make diagnoses in the lab which directly impact the treatment of our patients in the clinic. This ‘bench to bedside’ aspect of our job is quite unique in medicine. These skills also open doors to cutting-edge research, hopefully leading to exciting new therapies and better patient outcomes.”

Dr Stephanie Wallwork

< Back to contents

33

Immunopathology

34

RCPA Career Guide

What does an immunopathologist do?

Immunopathologists are medical doctors who specialise in studying, diagnosing and managing diseases that affect the immune system. The human immune system is complex and when it is underactive, it can lead to immunodeficiencies, resulting in infection. If the immune system is overactive, it can lead to autoimmune and allergic conditions.

Autoimmune disorders result from the immune system’s misdirected activity against the patient’s own tissues.

This can occur in diseases that affect the skin (lupus erythematosus), the joints (rheumatoid arthritis), the pancreas (diabetes), the thyroid gland (thyroiditis, Graves’ disease), the blood clotting system and conditions that affect the internal organs. Every organ in the body can be affected by immune-based diseases. When allergies occur, the immune system is triggered by external environmental stimuli. Immunopathologists are involved in the design, performance and supervision of tests of the immune system.

This medical speciality offers a balance between clinical practice and laboratory medicine. Some immunopathologists see patients, who may be referred when there is a suspected immune system component to their illness. In this setting, immunopathologists can advise on various disorders, including recurrent miscarriage and transplantation medicine, and can be directly involved in managing patients with autoimmune diseases such as acquired immunodeficiency syndrome (AIDS).

In the laboratory, immunopathologists are involved in examining specimens from patients to determine the cause and diagnosis of disease, performing tests to determine the reason or progress of diseases and consulting with other doctors to develop patient management plans. Immunopathologists may also be involved in the management of laboratories to ensure quality processes. Furthermore, many immunopathologists are engaged in research, and this speciality has significantly contributed to developing new tests and new disease management protocols.

Training pathway To become a laboratory immunopathologist, you need to first complete your medical degree and at least two postgraduate clinical years. You may choose to undertake the basic pathological sciences (BPS) examination during this time. This exam is a requirement for all Trainees and may be completed before or during training (before completing Part II examinations). You can complete the BPS examination as a medical student for a reduced fee.

Specialist single-discipline pathology training The training time for specialist single-discipline pathology training is typically five years in a training position accredited by the RCPA. During this time, a registrar trains in the dynamic field of laboratory immunopathology.

Immunopathology joint training options You may elect to undertake both laboratory immunopathology and clinical immunology training and apply for joint training with the RCPA and the Royal Australasian College of Physicians (RACP).

Did you know?

The speciality of immunopathology can be traced back to medical pioneer Edward Jenner who developed the concept of vaccines and the very first vaccination to prevent smallpox.

Day in the life of an immunopathologist

< Back to contents

35

Microbiology

Day in the life of a microbiologist

36

RCPA Career Guide

What does a microbiologist do?

Microbiologists are medical specialists who investigate patients with suspected infections. They are doctors that diagnose and help treat infectious diseases at the individual patient, public health and global level. These infections are the result of microorganisms that cause disease. Microorganisms can be bacterial, viral, fungal or parasitic and include SARS-CoV-2 (COVID-19), the common cold, influenza, human immunodeficiency virus (HIV), golden staph (MRSA), measles and hepatitis B. Microbiology is a dynamic field with new microorganisms emerging and old microorganisms re-emerging.

Microbiologists advise other medical practitioners about the best specimen to collect and which pathology tests to order. Clinical microbiologists see patients with complicated infections and recommend which antibiotics to prescribe, and they work closely with infectious disease specialists and infection control practitioners. Their advice is essential and crucial to the issue of drug-resistant organisms.

Microbiologists liaise with public health authorities regarding infectious diseases, such as salmonella food poisoning and COVID-19. During the COVID-19 pandemic, microbiologists significantly contributed to the community’s wellbeing. The entire healthcare system relied on COVID-19 testing at pathology laboratories to locate and monitor the virus and help protect the community. Microbiologists provide input into national vaccination strategies and public health measures.

Infectious diseases are a global issue, and the COVID-19 pandemic is an example of how devastating the impact of infectious diseases can be at an international level.

Governments of all levels and international organisations such as the World Health Organization (WHO) rely on advice from microbiologists on critical issues such as disease spread and the threat of biological warfare.

Microbiologists are at the forefront of science, developing new tests and methods to diagnose and treat infections. Recent advances in technology and molecular medicine have significantly added to microbiology diagnostic resources and equipment. This means there are many opportunities for research in the subspecialties of bacteriology, virology, mycology and parasitology.

Training pathway To become a laboratory microbiologist, you need to first complete your medical degree and at least two postgraduate clinical years. You may choose to undertake the basic pathological sciences (BPS) examination during this time. This exam is a requirement for all Trainees and may be completed before or during training (before completing Part II examinations). You can complete the BPS examination as a medical student for a reduced fee.

Specialist single-discipline pathology training The training time for specialist single-discipline pathology training is typically five years in a training position accredited by the RCPA. During this time, a registrar trains in the dynamic field of laboratory immunopathology.

Microbiology joint training options You may elect to undertake laboratory microbiology and clinical infectious diseases training and apply for joint training with the RCPA and the Royal Australasian College of Physicians (RACP).

Did you know?

Some viruses can cause cancer.

For example, human papillomavirus (HPV) can lead to cervical cancer.

Microbiologists are at the forefront of science, developing new tests and methods to diagnose and treat infections. < Back to contents

37

Why I chose immunopathology “For me, pathology is all about using your brain, using your creativity in a practical way to help patients and talk with other doctors, helping them understand diagnostic tests. I am fascinated by the immune system and immune disorders can be common, such as allergy or incredibly rare illnesses that are one in a million.”

Dr Alice Grey

38

RCPA Career Guide

Why I chose microbiology “During this era of testing for coronavirus, we have had to develop tests during a short period of time and expand our capacity, with a huge public health implication and interaction. If you really love science and want to work with people, microbiology pathology is an excellent opportunity to do both.”

Dr Roselle Robosa

< Back to contents

39

Useful resources and links Australia

New Zealand

Australian Medical Council

Medical Council of New Zealand

Ensures that standards of education, training and assessment of the medical profession promote and protect the health of the Australian community.

Ministry of Health NZ

Australian Health Practitioner Regulation Agency (AHPRA) AHPRA is the administrative arm of the Medical Board of Australia which is responsible for medical registration.

Australian Pathology

Asia Department of Health Hong Kong Ministry of Health Malaysia Ministry of Health Singapore

Australian Pathology is the national peak body for private pathology in Australia. Members include both small, specialised laboratories as well as large organisations with laboratories nationwide, representing more than 95% of the industry’s pathology services in Australia.

Educational Commission for Foreign Medical Graduates Electronic Portfolio of International Credentials (EPIC) For verification of both primary and specialist qualifications.

Australian Department of Health This website and integrated health tools provide access to reports and summary tables about the health workforce across all of Australia.

Medical Board of Australia Ensures that Australia’s medical practitioners are suitably trained, qualified and safe to practise. Public safety is our priority.

Public Pathology Australia Public Pathology Australia is the national peak body for public pathology in Australia. Members are the major government owned and operated pathology services in each state and territory in Australia. This includes the vast majority of pathology services in Australia’s public hospitals, as well as a number of private hospitals; members also operate community-based collection services for patients on the request of GPs and specialists.

40

RCPA Career Guide

RCPA Curriculum and Training Handbooks

Who to contact Contact the RCPA’s Training, Education and Assessment Team for all training, examination and assessment queries via email. bea@rcpa.edu.au

< Back to contents

41

Begin your career in pathology.

RCPA.EDU.AU

Contact us +61 2 8356 5858 rcpa@rcpa.edu.au

Find us Durham Hall 207 Albion Street Surry Hills NSW 2010 Australia

Connect with us /TheRoyalCollegeOfPathologistsOfAustralasia @the_rcpa /the-royal-college-of-pathologists-of-australasia-rcpa @PathologyRCPA