(upbeat music)
- This is Lab Medicine Rounds,
a curated podcast for physicians,
laboratory professionals, and students.
I'm your host, Justin Kreuter, the Bow Tie Bandit of Blood,
a transfusion medicine pathologist at Mayo Clinic.
As we've experienced snow
and colder weather here in Minnesota,
we thought it would be fun to continue to travel south
and connect with some of our colleagues
at the other Mayo Clinic campuses over these winter months.
And today we're rounding with Dr. Yasmeen Butt,
and Brittney Thiele.
Dr. Butt is an assistant professor
of laboratory medicine and pathology.
And Brittney is a medical student,
both of them at Mayo Clinic in Arizona.
And what we're gonna be talking about today
is talking about they've started a pathology interest group.
And what we wanna do is kind of explore that,
'cause I think that'll be really interesting
for our audience.
So thank you for joining us today, Dr. Butt, and Brittney.
- Thank you. - Thank you for having us.
- Awesome, so let's get started,
'cause this is an important thing,
I think, to give our listeners.
We're really talking about this pipeline
of attracting very talented students
into pathology and laboratory medicine.
From your points of view,
why do you think it's important
to start a pathology interest group?
- Yeah, I can start that from a student's perspective.
So I'm applying a PCP this cycle to be a pathology resident.
And for me I felt very fortunate coming into medical school
because I already had some background
seeing what a pathology career would look like,
what pathologists do, et cetera.
But coming into medical school,
there's a huge emphasis on clinical experiences
that involve direct patient care a lot of times
as it should, 'cause students have to learn
how to cultivate skills, to do a history,
a physical exam, et cetera.
So they get exposure to a lot of specialties in medicine.
But one that is unfortunately not front
and center tends to be pathology.
And that's somewhat unfortunate
because as some of the pathologists here have said,
pathology is one of the best kept secrets in medicine.
But it shouldn't be a secret
'cause it's such a great career option for students.
So starting an interest group is important for students
to be able see what pathologists do.
We have pathologists who teach courses
at the medical school,
who help students with their histology
or pathology for example,
but that doesn't tell students what the day-to-day ins
and outs of a job in pathology looks like.
And so to be able to have a group
where students can see what an anatomic pathologist does
at the scope, or what somebody who is a laboratory manager
or transfusion medicine, something like that.
They can actually see what that looks like
and hear about it,
and hopefully then put it on their list of things
that maybe they'd be interested in going into.
So that is something that's important for an interest group
and bringing that careers in pathology option
to the table for students in the school.
And I think whether students choose to go into pathology
or something else, it's useful for them
because pathology touches every aspect of patient care.
And so down the road,
even if they're in internal medicine or something,
they'll know where their biopsy is going,
they'll know who to call if they have a question
about blood bank or something with the lab.
So there are a lot of advantages
to having a pathology interest group
and exposing students to pathology.
And then I think finally myth busting is kind of big deal.
There's a lot of misconceptions around pathologists
and being kind of reclusive in the basement or something,
and being able to see pathologists and interact with them
and hear what their day-to-day looks like
and their interactions with clinicians
and that sort of thing has been really good for students.
And a lot of students have come up to me and said,
"Oh, wow, I didn't realize pathologists actually,
some of them see patients or that they actually interact
with clinicians throughout the day or that sort of thing."
And so to be able to kind of myth bust is helpful too.
- It's awesome.
Dr. Butt, kind from your perspective, it's a faculty mentor.
I imagine you kind of bring some of the similar perspectives
that Brittney brings, but also some additional ones.
- Absolutely.
I think that was so well put, Brittney.
I almost have nothing else to add to it.
But I think from a faculty perspective
and just from our specialty in general,
there is a lack of understanding
in the medical school community,
and honestly sometimes in our colleagues
and practicing physicians of what pathologists do.
And just like you said about myth busting,
the idea that, "Oh, well, all your patients are dead.
You only do autopsies, right?"
And that could not be farther from the truth.
That said, autopsies are a great source of education
and I am an auto fan myself.
I always have to add that caveat in there.
However, the majority of things that I do day-to-day,
the patients are alive and we're trying
to help to keep them that way and help guide treatment.
So certainly having that pathology interest group
is really valuable.
And I think especially from a medical school perspective,
it's really useful to have a place
for students to go like a touch point
if they wanna find out more about pathology.
And that is compounded by the fact
that there isn't a required pathology rotation.
Most medical students only interact with pathologists
as teachers in their early years
in their first and second year.
And so that can lead to a perception that,
oh, we're teaching more of the basic science information
in anything, and maybe histology.
but as you said, Brittney, they don't have an idea
of what it is that we actually do on a day-to-day basis
and how we impact patient care on almost every level
in almost every single specialty.
And so I think having a touch point
for those students to go to,
regardless of whether they wanna go into pathology
or if they're just interested to learn more about it
as a specialty, I think it's so valuable.
For me, my thoughts about a pathology interest group
are twofold.
One, you wanna be able to spark the interest
in the couple of students in every class
that are potentially gonna go into pathology.
And then two, serve as a source of information
for those that aren't.
I think the more you know about pathology,
it will only enhance your medical career going forward,
because whether or not you are aware of our existence,
we're impacting your medical decisions every day.
- It's well put.
Both of you, one of the things
in preparing for this podcast,
I was reading, I think, just the other day,
I saw CAP put out a commentary about,
part of the challenge is demonstrating for medical students.
What is that actual work of a pathologist look like?
Which I know Brittney, you very well articulated.
And so I'm kinda curious
if you could kind of explain for our listeners
who maybe they don't have a pathology interest group,
and they're looking to maybe start one up.
Or maybe people have an established interest group,
but they're kind of looking at retooling,
critically examining
on what can they kinda work forward on the next year.
So what are some important elements
that you think are important
for a successful interest group in your experience?
- So that's a great question.
And as you mentioned CAP, I'm also involved
in the CAP Pathologist Pipeline Initiative.
And because it's something that is really important
to looking into the future of our specialty
is recruiting the next generation of people
into our specialty.
And I think there are a couple of successful elements
you can integrate into any pathology interest group
regardless of size.
One of the simplest and easiest things you can do
is create a round table,
a workshop-type event for first years.
Try to gather folks from AP, from CP, from different areas,
to give students the ability to ask questions
about what it is to be a pathologist.
And so those are very simple events to set it up.
Even in the Zoom age, you can set them up on Zoom
or ideally if you can have them in person,
and just to have interested students in first year come.
Oftentimes I think these medical students don't realize
or think about pathology as a viable career
until maybe they do an elective in their fourth year.
I've known actually more than in one person
who did an elective and fourth year
after they matched another specialty
and decided they wanted to change and go into pathology.
So it does happen.
And so creating that workshop event
or just kind of like a round table with pathologists,
I think geared mainly towards first years,
but certainly second years and third years as well,
to give them an idea and different perspectives
of the different types of career you can have in pathology.
Because that is something I think is quite valuable
about the specialty is you can have such a wide variety
of careers, and you can be an anatomic pathologist
and look at biopsies all day.
You can be in blood bank and be managing a forensic patient
and dealing with reactions in totally different worlds,
but under the same umbrella.
So I think that's the number one thing
that would be very simple to do and allows you
to contact with students who may be interested.
And after that,
there is so many different ideas of activities.
And CAP has a lot of ideas
that they've put up on their website,
which are definitely worth looking at.
If you have a small group
or you're thinking about starting a group,
they can range from, if you have a strong cytology area,
you could do FNA clinics.
That's something that we actually are in the process
of planning for our group
now that some of our COVID restrictions have lifted.
And that's a really hands-on procedure
and does highlight one of the ways
that pathologists do actually have direct patient contact.
Doing, finding needle aspiration biopsies
on patients in a clinic setting.
So you can set up something like that, would be very nice.
We also had a nice event with donating blood
that Brittney spearheaded, which was really nice.
So we had competition
between all the different medical school classes
on who could donate the most blood
and that was run by the pathology interest group.
So that was really nice.
So basically exposure also, you can set up lab tours.
You can say, hey, if you're interested
in coming to see what the lab is like,
see the histology lab, see the clinical chemistry lab,
the microbiology lab, invite them to plate rounds.
Those are always fun.
So those are opportunities
where you can engage medical students
in the practice of pathology.
- I'm glad you mentioned that resource
that we can put in the show notes.
- Yes, I think it's an excellent resource.
The CAP has put a lot of time and effort
into coming up with ideas
and helpful things that people can do.
And everyone is gonna have a different capacity
to do some of these activities,
but I think there's something for every group,
for every size, that they can do on that website.
- Wonderful.
So Brittney, I'm kinda curious.
Dr. Butt kinda talked about all these wonderful ideas
to integrate and is very involved really
at the national level in kind of this pipeline
of brilliant folks tracking into the field.
From your perspective,
what you've seen with the medical students
that have been involved with the group,
is there one or two activities
that really kind of stands out as has been perceived
as really the most valuable and best experiences so far?
- Yes, so really the experiences that are linked to courses
that they are currently in tend to be the most successful.
So it tends to recruit people
who may otherwise not come to those events,
and then discover, "Oh, that's quite interesting."
So one of the events that was very successful
was the first year's anatomy course.
We had the general chief medical examiner
from the Medical Examiner's Office here at our county,
come and speak about forensic pathology.
And a lot of students were really interested in that,
and thought it was very fascinating hearing
kind of the public health side of forensic pathology,
as well as what they do with autopsy.
That was really interesting to them.
And I've gotten students since then
who've been really interested
in wanting to observe an autopsy
or wanting to spend some time over at the ME's Office.
So that was very successful, and it correlated well
with what they were learning in their course.
And then kind of what Dr. Butt mentioned
about the round table,
that's also been a very successful event for us
because students can really get a glimpse
into what the various specialties and pathology are.
And especially during their pathology course
where that's kind of more on the forefront of their mind,
there are more apps to come
and explore what that might look like.
So those two, I think, have been some
of our more successful events
and have really garnered student interest.
- One of the things that just popped in my head right now,
we put some emphasis on understanding,
what is that work that a pathologist is doing?
And I'm curious for some of us
as we get into practice longer.
We sort of forget that beginner's mindset.
And I'm kinda curious, has there been any challenge
with some faculty being able to explain
or demonstrate their work?
Or is there any way that has been important
to kind of coach faculty or direct faculty during a session
so that they can really truly show
what is the work that they're doing?
- Well, that's a really good question.
And I'll have Dr. Butt elaborate on that a bit more.
But what I will say is that here at Mayo, Arizona,
I feel like a lot of the pathologists
are educators at heart.
I feel like they really have been involved in our courses
and they really want to teach
and have been enthusiastic about that.
So from my perspective, as a student,
I haven't seen any situation where I thought,
"Oh, maybe that didn't go so well."
Like really they came in ready and eager to talk to students
and able to articulate what they do
in a way that students can understand.
So I feel like from my perspective I haven't.
But Dr. Butt you've interfaced with them more than I have.
- Well, I'm glad to hear that we've had a positive impact.
And you come across just good educators.
So that's what we all strive for.
That really is an interesting question.
I would say I have not run into that personally.
And I think part of that is just by selection bias.
So certainly the people that show interest
in coming to these round tables,
and the people that are involved
in teaching medical students.
It's essentially a volunteer basis.
In our department, I mean,
certainly that the teaching needs to happen,
but there are enough people
that want to teach that are involved.
So we're not dragging anybody,
kicking and screaming to teach our courses.
So I think we've had generally positive age experiences
with that from the faculty side.
But I could see perhaps if there was a program
where everyone had to teach
and maybe not everyone would prefer to teach,
certainly there might be useful resources.
Maybe CAP has useful resources saying
how to explain your job to medical student.
But I think a self selection bias is important there
to have people actually interested and invested
in education and reaching out to medical students,
being the people that interact with medical students most.
And I'll say that medical school curriculum,
this is a little bit of a tangent,
but it touches a little bit
on what we were talking about before
with involvement on the course level,
because I do agree.
I think as much as you can link your events
and your inner actions with the courses
that the students are taking,
because let's face it, medical schools are consuming.
You're spending hours and hours a day studying.
You don't have a lot of time for extra things.
I think is those activities that link to the courses
are gonna have the most success.
And so certainly, medical school curriculum is changing
and it's changing across the country,
both at Mayo Clinic and everywhere else
to a more integrated type of curriculum,
where you're trying to bring everything together.
So rather than having discreet ways of learning,
okay, we're gonna learn,
we're gonna learn the histology of this in histology.
And then you're gonna learn the physiology of this
when you do the cardiac block and everything more separated.
We're going into more combined ways of educating students.
And so I think then the burden
or whatever words you wanna use falls back
on pathology faculty to become as involved as possible
as they can with these more integrated curriculum courses.
Because if we're not there to talk
about our portion of these things,
then we're gonna get lost in the background.
And it's not that we're not doing the work,
but no one realizes that we do it.
Time and time again,
when I talk to people outside of medicine
and they're like, "What do you do?"
And I'm like, "Oh, I diagnose cancer."
And they're like, "Oh, yeah.
So-and-so got a diagnosis of cancer from their oncologist."
I'm like, "Actually that came from a pathologist."
So we're very easily lost in the background
if we're not advocating for our specialty
and educating about what we do.
So I think from a faculty perspective,
as much as you can step up and become integrated,
be at the table, get involved in those courses,
I think the better off you'll do.
But from a pathology interest group,
something that we're doing here,
so we have gross labs incorporated
into our MS1 pathology course,
of course, of course, of course.
But for some of the other courses we don't always.
So our cardiac block does, but pulmonary doesn't.
And so, of course I would like to have things integrated
into the courses themselves but that's not always possible
because we have more and more limited time
to go over these classes and to get into lecture
to give this material.
So time is always limited.
So a potential pathology interest group activity
that you can do is a gross lab session.
Collect a bunch of interesting specimens,
and when the students are going through, say, for example,
their pulmonary block, have 15 cases of lung cancer,
sarcoidosis, interstitial lung disease,
whatever cool cases you can get together
and just have an event and have them come.
And you can say, "Hey, you learned about this in class.
Here's what the actual cancer looks like grossly.
Like not just from a PowerPoint picture.
Why don't you hold it?"
So I think linking those activities as much as you can
to the actual courses provides a really valuable,
and literally in some cases a hands-on experience.
- And I should say, you can see Dr. Butt's enthusiasm
with all of this.
And so when starting an interest group at any location
it's so important to have someone like Dr. Butt,
who is very excited about medical student education
and really furthering pathology.
And so for me, it was great
and I think any student who might be interested
in starting a pathology interest group,
look for a faculty member who is excited
and really interested in get getting
that whole department involved
in helping to really start these things.
Because I think Dr. Butt has been absolutely instrumental
in making a lot of these things happen
and really helping to bring pathologists on board
to join and be part of these events.
So that's critically important
for students who wanna start an interest group.
- So as we're recording this in February of 2022,
COVID and the pandemic is still a present reality for us.
And I'm kinda curious about, has the pandemic had an impact
on how you approached the pathology interest group?
- Yes (laughs).
So we started the group in March of 2020.
So as you can imagine
that was right when everything kind of shut down
and that made it somewhat challenging
to really start engaging students right off the bat.
So we did a lot of,
we did two Zoom events right off the top that were good.
And it's difficult I think sometimes
when students are get trying
to understand what a new group is,
to then join with Zoom and all of that.
So it took a little bit of doing,
but I think especially now
as restrictions have kind of lessened a bit
and we were able to do some in-person events
with more social distancing,
students have been a lot more engaged
and it's easier to interface with them
and have them ask questions
and interact with them even after the event's over.
So that has been good,
but it certainly was a little bit challenging
to get it off the ground at first,
because we really had to think creatively
on what can we present to students over Zoom?
And I think everyone in the world was thinking,
how can we present things over Zoom?
So we were just kind of caught in that as well.
- Yeah, I totally agree.
Brittney has been an amazing advocate.
She came to me with the idea
of starting a pathology interest group.
So kudos there for making this happen.
But we could do minimal things because of COVID.
And I think, like you said,
we're all stuck in that same sort of doldrums
of, well, we can only do, we can do over Zoom.
So I think having those round tables was really valuable.
At least we were able to connect with students
who showed some interest in pathology through that.
But I am so grateful that restrictions have started to lift
and we're actually able to do more things in person.
But I think best teaching happens in person.
I really strongly believe that.
And that goes for pathology, and any other type of teaching.
There's always gonna be a limitation to Zoom
when you're far away, and you're not in person
and you're giving your talk to a blank screen,
and everyone has their cameras off
and you don't know what's going on.
Are they sleeping, what's happening?
Are they just gonna listen to it later and speed me up?
So that's fine, but in person is always the best.
So hopefully things will only improve from here on out.
- I mean, that makes my medical educator heart
go pitter-patter.
The relationship is very important, right?
Between learner and mentor,
this whole idea of being a guide on the side,
helping our learners construct what we know in our heads
in their own heads, that that takes work,
that takes guidance.
And certainly that video off Zoom,
that connection is problematic at best maybe (laughs).
I'm curious then, we've kind of gone through it.
And one of the things that really resonates with me,
I'm sure for our audience too,
is that you're really highlighting for me this concept
of it's not just pathology interest group,
people that are interested in the career of pathology,
but I think that you've made the point very well here
that it's also for those who want to be able
to use pathology in their career.
In other words it's time well spent.
It's value add regardless
of what specialty somebody might choose.
And that's really impacted me
with what you guys have said today.
And I'm curious, as you go forward in the future
of this interest group, what are your thoughts for,
how are you planning to be iterative
and try next year that you didn't try this year?
What are ways that you're interested in moving this forward?
- I think that that's a really good point
that you pulled out and I couldn't agree more.
I think a pathology interest group
is not just for people who wanna go into pathology.
Certainly those will be the people
that will be most invested in, go to every event
and be involved in it.
But it comes back to basic values.
The needs of the patient come first.
And in my mind,
the more our future physicians know about pathology
and what pathology can do for them
and aid them in the care of their patients in the future,
the better physicians that they'll be.
And so creating events, like the blood drive
that Brittney put together.
And like gross lab presentations,
where you can see different specimens
and really gain an understanding,
a visceral understanding of what it is,
these disease processes that you're learning about.
Observing an autopsy.
You may be an ICU doctor in the future
and you may remember, "Oh, yeah, I observed that autopsy.
And they found out some fascinating information
that we didn't even think about."
And maybe that can be useful
and that you might be more likely to send for an autopsy
and learn something and advance your knowledge
and your colleagues' knowledge
and might turn out better for a patient in the future.
So I think there's so much value to be had
by educating students on what their pathology colleagues
can do for them in the future
in whatever field that they choose to go into.
And so I think creating events, I mean,
honestly all the events, I think,
would be valuable for anybody potentially
regardless of what field they go into.
But perhaps they can tailor it
towards what their area of interest is.
If you're planning on going into neurosurgery or neurology,
maybe spend a week shadowing the neuropathologist
at your institute.
You're gonna learn a lot, I guarantee you.
So I think that provides a lot of value.
I'm curious, anything else you wanted to add Brittney,
on that idea as we have for the future?
- Yeah, I mean, I think you said it very well.
It's so important to have students be exposed
to pathology and all that it is.
And like you said,
even if they go into various clinical specialties,
pathology touches just every aspect.
So knowing who to call, knowing what pathologists do,
and even wait times, "Oh, I took a biopsy.
I'm not going to get it an hour later."
You know the results.
Knowing those things is very important.
And so, I think looking into the future
as well for this group,
it's just kind of keeping the momentum going
and finding more ways to kind of curate the experiences
to the curriculum and also to student interest.
I know that certain classes now have people
who are more interested
in certain subspecialties than others.
So there are certain events then that you might think,
oh, okay, maybe we'll do something more
with this type of pathology subspecialty or this other one,
depending on student interest as well.
So really kind of feeling that out,
it is kind of an adaptable thing.
And remembering that it's gonna help students down the road,
whether they go into pathology or not.
Though fingers crossed,
we'll get some more people going into pathology.
'Cause that's super important.
- Yes (laughs).
- We've been rounding with Dr. Butt, and Brittney Thiele,
on pathology interest groups
that they started here at Mayo Clinic in Arizona.
Thank you both for being here with us today
for this Lab Medicine Rounds.
- Thank you. - Thank you so much
for having us.
- So to our listeners, thank you for joining us today.
We invite you to share your thoughts
and suggestions via mail.
Please direct any suggestions to mcleducation@mayo.edu.
If you've enjoyed Lab Medicine Rounds podcast,
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And until our next rounds together,
we encourage you to continue to connect lab medicine
and the clinical practice through insightful conversations.
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