Digital Pathology: Lagging or Leading?
Posted 4th May 2020 by Liv Sewell
When compared to traditional methods, digital pathology may seem totally superfluous, or interesting but not all that essential. And since the costs for the elegance of digital pathology solutions are not trivial in comparison to what the peddlers traditionally have offered, it is not surprising to see the adoption curve lagging. Where then is the ‘burning platform’ that can truly drive greater adoption of digital pathology?
Will pathology’s perfect storm become the burning platform needed?
The rapidly developing shortage of capable pathologists, particularly those with subspecialty expertise, coupled with a rising tide of non-communicable diseases such as cancer in both the developed and the developing world presents those working in pathology with a significant challenge requiring radical change and creative solutions. Education and training have long been areas where digital pathology has offered promise and has begun to deliver on this.
In the United States, the pathologist shortage is developing according to projections as an age-skewed population of pathologists retires, dies or otherwise leaves practice faster than new trainees enter the job market and workforce. This situation is constrained further by the inflexibility of the number of training positions (most are government funded) and the time-based rigidity of the certifying boards in pathology. It is a perfect storm, and one that few people are doing much about.
Faster, better, cheaper
One solution of course is to look to improve the efficiency of practicing pathologists. Many of the AI solutions coupled with DP that are being discussed at conferences such as the Digital Pathology and AI Congress, can be aimed to improve the throughput of a given pathologist. The sub-specialist trend in most departments, which can be facilitated by DP, also can achieve gains in productivity, as well as quality, at least two prongs of the holy grail triad of “faster, better, cheaper.”
But another somewhat neglected capability of DP is the ability to train pathology trainees to an enhanced level of competency faster than has been possible in the past. The very “random encounter” method of case-based learning that has been the cornerstone of not just pathology training, but of almost all of medical education generally, is only recently beginning to be challenged and supplemented with simulated patients, virtual reality labs, and other structured experiences to enhance and verify competency sooner in the educational process.
Few if any pathology training programs are applying these kinds of methods to train residents, though some have begun to use these in competency assessments. Some of the novel tools that are being developed and tested in our laboratory and others are aiming to show that the competency attainment in the diagnosis of certain components of surgical pathology can be accelerated by significant amounts through the use of structured training employing digital pathology tools. We are also in the process of developing virtual reality tools to accelerate the acquisition of grossing techniques, akin to the methods used to improve surgical skills for basic procedures.
Validating this process in the acquisition of basic competency in surgical pathology is just the beginning. Development of modules for enhanced sub-specialty training in various underserved subspecialties should also be amenable to this process. The potential to train and equip capable pathologists in three years instead of four, or to prepare sub-specialists via a combination of on-line tools coupled with in person mentored experiences should also be possible in a shorter overall time frame.
Digitally trained pathologists are the solution
Furthermore, it would be anticipated that training in this manner might create a different sort of professional network, one less tied to the “diva” of a particular specialty, and more tied to a community of colleagues, connected via digital tools, social media and other means to create a truly robust practitioner. In the world of training capable and competent pathologists, we really can do it faster, better, and hopefully also cheaper (though the time-based recoupment of our initial investments may force us to regard the long term.) Digitally trained pathologists can become the solution to the workforce crises that is surely looming ahead, and already evident in many locations.
Lewis Hassell is Professor of Pathology, University of Oklahoma. He spoke on ‘Leading or Lagging – Is Digital Pathology a Bane or Boon to Pathology Training Programs?’ at the 6th Digital Pathology and AI Congress: USA.
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