Pathologists' assistant training programs: a report

The History of Pathologists' Assistants: A Tale of 2 Educational Mavericks

Context.—

The use of medical technologists to assist with clinical pathology workload has been common since the 1930s. In stark contrast, most aspects of anatomical pathology have traditionally been considered to be medical work that must be performed by pathologists or residents.

Objective.—

To describe the history of the pathologists' assistant profession in North America.

Design.—

Available primary and secondary historical sources were reviewed.

Results.—

The concept of physician assistants, capable of performing delegated medical tasks, was created by Eugene A. Stead Jr, MD, at Duke University in 1965. When this profession began, it was quickly embraced by the American Medical Association, which took ownership related to certification and licensing of practitioners as well as external accreditation of training programs. Because of concerns about pathology manpower in the late 1960s, Thomas D. Kinney, MD, also at Duke University, developed the first training program for pathologists' assistants in 1969. Pathologists' assistants were not immediately accepted by many academic pathologists, especially related to work in the surgical pathology gross room. Organized pathology did not help the new profession develop standards, and so in 1972 pathologists' assistants created their own professional organization, the American Association of Pathologists' Assistants. Although it took several decades, the association was eventually able to forge relationships with the National Accrediting Agency for Clinical Laboratory Sciences for training program accreditation and the American Society for Clinical Pathology for board certification for practitioners. The development of the profession in Canada is also described.

Conclusions.—

The pathologists' assistant profession is now well established in North America.

Value-Added Benefits and Utilization of Pathologists' Assistants

Context.—The role of pathologists' assistants (PAs) in terms of surgical and autopsy prosection has been well established; however, the role of PAs in areas beyond surgical and autopsy pathology, such as laboratory administration and management, education, and research, is not so well understood.

Objective.—To determine the scope and extent of ancillary duties (value-added benefits) performed by PAs.

Design.—A self-administered, electronic survey was disseminated to all members of the American Association of Pathologists' Assistants with fellowship status to analyze the ancillary duties PAs provide in laboratory administration and management, education, and research.

Results.—Respondents were from 44 states and most had 6 or more years of experience in various work settings: community hospitals (50%), academic hospitals (30%), private pathology laboratories (15%), and “other” settings (5%). Most were involved in quality assurance programs (64.0%), laboratory accreditation inspections (56.2%), and a large percentage (44.4%) also had direct supervisory experience. Roughly 36% of respondents reported training residents in prosection skills in a clinical setting, while a small percentage reported teaching for-credit courses in a classroom setting (4.9%). The primary research responsibility was fresh tissue procurement for tumor banking (52.7%).

Conclusions.—Pathologists' assistants currently are involved in ancillary duties beyond surgical and autopsy prosection. Our findings indicate that PAs have a desire to become more involved in these duties, and there is opportunity for pathologists to benefit further by using PAs to the full extent of their knowledge, skills, and interests.

The impact of involvement of biomedical scientists in specimen dissection and selection of blocks for histopathology: a study of time benefits and specimen handling quality in Ayrshire and Arran area laboratory

AIMS

To assess possible time benefits of specimen dissection by biomedical scientists (BMSs) and the quality of specimen handling by BMSs, in a department where BMSs trim those specimens requiring simple descriptions, from which standard blocks are taken.

METHODS

Specimen handling by BMSs and consultant pathologists was compared. Time taken for each specimen trimmed was recorded prospectively. To determine specimen handling quality, adherence to dissection standard operating procedures (SOPs) was assessed by recording retrospectively whether or not each action in the SOP had been performed. Information on subsequently required extra levels or blocks was recorded.

RESULTS

Analysis of data from 672 specimens trimmed by consultants showed that any given action in the SOPs was performed on average on 60.2% of applicable/assessable specimens; for 660 similar specimens trimmed by BMSs, each action was performed on average on 80.1% of specimens. Of the specimens where data on extra blocks were recorded, extra blocks were required in 3% of those trimmed by pathologists and in 4% of those trimmed by BMSs. Extra levels were required in 12% of those trimmed by pathologists and in 16% of those trimmed by BMSs. BMS trimming saves 16 hours of consultant time each month. The difference between pathologists and BMSs in time for each specimen trimmed is negligible.

CONCLUSIONS

The advantages of increased adherence to trimming SOPs and saving consultant time outweigh the relatively small number of extra blocks and levels required when BMSs trim. There is no reduction in quality of dissection.