Pathology is the branch of medicine involved in understanding causes and processes of disease. Pathology encompasses the following disciplines; anatomical pathology, chemical pathology, haematology, immunology, laboratory genetics, and microbiology/ virology. Investigations are made by performing tests on various tissues including blood and other body fluids, and samples taken during surgery or as part of a medical examination. Pathologists interpret the results of these tests, which may show the cause or severity of illness or may be used to monitor treatment once diagnosis has been made.
There are 28 pathology trainees in the various Auckland training schemes, distributed between the specialties listed below. Training takes place at Auckland City Hospital for some specialties, while in others, registrars are rotated between Auckland City Hospital, Middlemore Hospital, North Shore Hospital and Diagnostic Medlab, to take advantage of the different learning opportunities and wealth of consultant experience in the different centres. This also satisfies the college requirements limiting the training time that can be accredited at any one institution.
Anatomical Pathology incorporates histopathology, cytopathology and forensics. It concerns the diagnosis of disease processes based on morphological abnormalities, both macroscopic and microscopic. Morphology is supplemented by a variety of ancillary techniques such as the use of special stains, immunologic techniques, and electron microscopy. In many cases, this information is integrated with that provided by other parts of the laboratory, (such as genetics, haematology and microbiology), in order to arrive at a diagnosis.
There are 16 trainees who rotate through a series of 4 month runs between the 4 institutions below. In addition, there is protected training time on Friday mornings with a formal teaching programme.
Labplus, Auckland Hospital
Trainees report histology and cytology, and most tertiary services are covered.
The Histology/Cytology laboratory has 13 FTE consultant staff, 15 scientists and 5 other support staff. Annually there are 20,000 histology accessions (approximately 35,000 specimens), 30,000 gynae cytology, and 4,200 non-gynae cytology cases. Subspecialty areas not covered elsewhere include paediatrics, lung pathology and neuropathology.
There is also exposure to forensic pathology through the mortuary where there are 5 consultant staff, 6 morticians, and 1 clerical staff member. Approximately 900 autopsies are conducted annually.
Middlemore Hospital Laboratory.
Trainees report a broad range of histology and FNA cytology, and there is particular exposure to orthopaedic pathology, breast pathology, and skin pathology from the plastics unit.
There are 7FTE consultant staff, 10 technologists and 1 clerical staff member.
Annual specimen numbers are 23000 histology specs, 1300 FNA cytology.
North Shore Hospital Laboratory.
Trainees report a broad range of general histology and cytology.
There are 5.6 FTE consultants together with 16 support (technical and secretarial) staff.
Annually there are approximately 14500 histology accessions (approximately 24,000 specimens) and 1500 non-gynae cytology specimens.
Trainees are rotated to DML for gynae cytology training. The Anatomical pathology laboratory has 12FTE consultants and there are approximately 30 gynae cytology screeners. There is also exposure to FNA cytology through outpatient clinics.
Chemical pathology involves the study and investigation of the biochemical basis of disease processes. The major role of a chemical pathologist is in fostering analytically satisfactory biochemical results to be used and interpreted appropriately by clinicians in patient care.
There are 2 trainee positions - one at Labplus, Auckland City Hospital , Auckland DHB (2 FTE consultants supervising) and one at Middlemore Hospital, Counties Manukau DHB (1.5FTE consultants supervising). Trainees rotate between these 2 centres in 6mths to 1yr rotations. These positions are predominantly training focused with a secondary role in supporting a primarily consultant-driven service.
Haematology is a discipline which encompasses the scientific, laboratory and clinical aspects of primary disorders of the blood as well as how other diseases affect the blood. It also includes transfusion medicine.
Training in haematology may be undertaken through one of the following 3 schemes:
1) Joint training with the Royal College of Physicians (RACP) and the Royal College of Pathologists (RCPA). This is a 4 year program of clinical, laboratory, and research aspects of haematology, leading to admission to both FRACP and FRCPA, and the ability to practise as a clinical and laboratory haematologist.
- Entry into the joint training scheme follows successful completion of the Written and Clinical Examinations of the Part 1 FRACP Examination and the basic physician training.
- Trainees must be enrolled with both Colleges throughout training, and will be required to successfully complete Part 1 and Part 2 Examinations in haematology conducted by the RCPA.
2) Laboratory training in haematology with the RCPA. This is a 5-year program leading to the award of FRCPA and the ability to practise as a laboratory haematologist. Trainees must register with the RCPA. There are 3 examinations which must be completed:
- Basic Pathology Science Examination
- Part 1 after at least 3 years of laboratory experience: including Written, Morphology, Serology and Blood Banking wet practical, Dry practical and Viva examinations
- Part 2 at the end of the training but at least 1 year after passing Part 1: including a formal dissertation and viva examination.
3) Advanced training program in clinical haematology with the RACP following the successful completion of the Written and Clinical Examinations of the FRACP Examination and basic physician training, and is supervised by the JSAC in haematology. This is a 3 year program, which includes a compulsory 6 month training period in laboratory haematology, but no formal examinations are conducted. The advanced training program in clinical haematology leads to admission to FRACP and the ability to practise as a clinical haematologist.
The Pathology Vocational Training Committee looks after haematology trainees in the Joint Training or Laboratory-only training schemes. There are 5 positions for haematology training: 3 in Auckland City Hospital including one rotating post to New Zealand Blood Service, 1 in Northshore Hospital, and 1 in Middlemore Hospital. Trainees rotate on 4-month runs to these hospitals/NZBS. They work under supervision and attend structured teaching sessions to acquire the knowledge and experience in laboratory haematology and transfusion medicine. All trainees in the pathology/haematology runs regardless of the training stream are expected to take up limited amount of clinical work, which will be important for their haematology training.
Trainees have the option of training in either immunopathology alone or jointly in clinical immunology. Trainees in the joint program will need pass the FRACP part 1 exam before commencing in immunopathology. Those wishing to undertake the joint program should discuss their plans with both the clinical immunology service as well as with the laboratory service. The immunopathology exams consist of a part 1 and part 2. It is expected that the trainee will be in a position to direct an immunopathology service by the time they have completed the part 2 exam. The immunopathology service at Auckland Hospital offers a very broad array of training opportunities including molecular immunology. The lab has an active research program in primary immune deficiency disorders. There may be opportunities to enter a PhD or MD program as part of training.
Laboratory Genetics is concerned with the study of genetic diseases, which encompasses single-gene defects, multiple-gene disorders, or chromosomal defects, together with the advancement of genetic testing and related technology. The emphasis in training concerns hands-on laboratory work that addresses the core competencies of human genome analysis and the scientific interpretation of genomic data. Training also involves all aspects of test development, with a strong emphasis on high-level oral and written skills. Registrars do not rotate through other hospitals, but stay within LabPlus of Auckland City Hospital.
There are currently three training positions in microbiology across the Auckland region. It is hoped that funding for a training position in virology can be secured for 2012. Registrars rotate yearly.
Labplus, Auckland Hospital.
Trainees participate in the day to day running of the Microbiology Department. They provide clinical support for the testing performed in the Department including the interpretation of laboratory results, providing advice on the collection of specimens and the management of infectious diseases. Registrars participate in the Adult Bacteraemia Service on a rostered basis seeing patients with positive blood cultures.
There are 2.15 FTE consultant staff, 58 FTE scientists and other support staff. The Department provides the most comprehensive microbiology diagnostic service in New Zealand. Within the Department is the National Mycology Reference Laboratory, the National Anaerobe Reference Laboratory and the Mycobacteria Section undertakes molecular typing of all isolates of Mycobacterium tuberculosis.
The Clinical Microbiology Service also provides support for the Infection Control Service at ADHB and has a strong leadership role in national infection prevention and control initiatives. The Service also has a strong interest in hospital epidemiology.
The Virology Department provides the leading clinical virology service in New Zealand. Virology is an integral part of the microbiology curriculum; all trainees are required to show competency in this area. The Virology Department at ADHB performs viral culture, direct antigen detection methods and an extensive array of molecular assays for diagnosis and monitoring disease activity.
Middlemore Hospital Laboratory.
Middlemore Hospital is one of the largest tertiary teaching hospitals in New Zealand. Annually, it admits more than 91,000 in-patients, and handles in excess of 354,000 day-patients and outpatient attendances.
Trainees are exposed to a broad range of microbiology at Middlemore with particular exposure to orthopaedic infections, skin and soft tissue infections from the Plastics Unit. The hospital services South Auckland with its high numbers of Maori, Pacific and relatively youthful population. Unwell travellers arriving at the nearby international airport also present to this hospital.
There are usually more applications than there are positions and candidates are strongly advised to ensure that an up-to-date CV accompanies the application along with any relevant supporting documents. The candidate must state clearly his/her preferred discipline in Pathology in rank order if more than one discipline is being applied for. Candidates are usually required to present for an interview.