The consultant biomedical scientist role in dermatopathology
Consultant biomedical scientist roles are no longer the rarity they once were. RCPath/IBMS examinations in cellular pathology have begun to open career pathways that will allow these roles to become more commonplace over time, as Guy Orchard explains
This has also been made more desirable as we see the decline in the number of pathologists currently in training, which is not adequate to sustain the pathology services in the future.
The situation has become increasingly serious recently as many departments are struggling to recruit suitably experienced personnel to fill the reporting roles. This trend is set to escalate and is the trigger for interest in the development of the reporting examination pathways for biomedical scientists.
Dermatopathology remains one of the largest specialties within cellular pathology and offers many opportunities for biomedical scientist role development. It is not only in the field of reporting that biomedical scientists will be needed to fulfil a growing demand, but also in tissue dissection to enable the management of a growing workload and to free more time for pathologist reporting. So, in order to prepare for these advanced and consultant roles, what are the qualities that someone seeking to aspire to these positions should display?
I would put experience at the top of my list. Specialist dermatopathology services involve specialist techniques and the interaction with specialists from other teams; specialist biomedical scientist knowledge of the service, the skin and its pathology are key and can only be developed with time. The ability to learn and improve through experiences gained is also a key quality for our consultant roles. There are clearly core skills, there are complex skills, and there are skills that we need to perfect and update constantly. All of these lead to the development of highly trained, experienced and forward-thinking individuals who seek to make a significant contribution to the departments in which they work and the service they deliver.
Having been a biomedical scientist for nearly 35 years, and nearly all of that time spent in the same laboratory, I have seen the evolution of our discipline during that time and the increase of our understanding of our science and our services. What is the point then of gaining a wealth of experience and knowledge, if you simply don’t use it to its full effect? In this regard you need to be focused on improving, challenging and also developing concepts that deliver improvements to the service and ultimately contribute to patient care. This, of course, can take many forms and I have discovered in dermatopathology it may involve the research and development of new diagnostic tests that improve the armoury of investigative testing used to diagnose or improve patient diagnostics.
I challenge anyone who says that biomedical scientists do not do research; certainly it is not usually the main purpose of our role, but without the application of our knowledge and experience, how can we develop our services and take them forward? Experience gives one knowledge, and once you have gained an understanding of the key knowledge sets, it’s a natural development for those with a curious mind to question and challenge traditionally help concepts. Put simply, this is how we improve!
The ability to communicate well with a wide cross-section of professional groups is always important. In working practice this can come in many different forms. Examples in my area include advising at MDT consultations on patient management pathways or communicating directly with the surgical teams performing Mohs tissue removal for facial tumours.
Mohs is a growing area of dermatopathology and the increasingly common, locally spreading, basal cell carcinomas can be large and challenging tumours to remove without leaving disfiguring scars. There is quite often discussion around the tissue pieces removed and how best to maximise the information that can be gleaned from them. There is also a requirement to deliver results in a timely manner to minimise discomfort to patients, who remain surgically ‘open’ while awaiting the results of the frozen sections. Arguably this is a good example of near-patient testing in the field of cellular pathology, and biomedical scientists are a key component in this patient care pathway.
The purpose of Mohs is to remove tumours with minimal excision margins, while taking several layers of tissue for examination, and at the same time maximising the preservation of normal tissue from the face with the aim of giving the best cosmetic end result. The role of the consultant biomedical scientist is integral to this process to ensure that the entire surgical process is completed within a one-day clinic visit.
Other examples include evaluation of dissection procedures for complex tissue types that may require discussion with consultant pathologists. There is also the need to discuss and direct new service developments that may require careful planning and which may have far-reaching effects on many staff working within the department. Lecturing and presenting at meetings is always a good way to develop these essential verbal communication skills. Good communication is not confined to the spoken word but also encompasses the written word. This could include contributing to the scientific literature in the form or publications, writing chapters in books or even authoring books on cellular pathology – all would constitute characteristic traits.
I would like to conclude by mentioning perhaps one of the most significant requirements of them all. The ability to lead! The role requires a mentality that demands leadership qualities in abundance. That means being able to consider all aspects of the service need, being able to rationalise and then make the decisions needed to move forward. This often comes when all the above have been achieved and displayed successfully. Looking for strengths, working out weaknesses and gaining intelligence on best practice. This is the ultimate and constantly demanding and evolving skill!
About Guy Orchard
Dr Guy Orchard is Consultant Grade Biomedical Scientist/Head of Education for Tissue Sciences UK, Viapath Analytics, St Thomas’ Hospital, London. Guy is IBMS Chief Examiner in Cellular Pathology, sits on the RCPath/IBMS Conjoint Boards for reporting and histological dissection, and is a deputy editor of the British Journal of Biomedical Science. He has lectured internationally, published widely in the peer-reviewed literature, and has edited (with Brian Nation) textbooks on Histopathology and Cell Structure and Function in the Oxford University Press Fundamentals of Biomedical Science series.