Pathologist
Medical Laboratory Technologist/Scientist
Pathologist's Assistant
Clinical Chemist: To be added
Medical Microbiologist: To be added

Pathologist

Contrary to some people's belief, autopsy and blood testing are not the most important tasks a pathologist performs. It is the microscopic diagnosis on surgical specimens, biopsies and cytologic smears which are his main expertise. Four to five years of post-graduate training (residency) after a medical degree is required in order to practice pathology. Further training of 1-2 year duration (fellowship) is available in sub-speciality areas of pathology. After completion of training a certification is required to be recognized as a pathologist. Career choices include practice in an academic environment, in a community hospital or in an independent laboratory either as an employee or as partner. Two major divisions of pathology are:
1) Anatomic Pathology: It is based on morphologic diagnosis rendered by gross and microscopic examination of tissues and cells. Its subdivisions are: Surgical Pathology, Autopsy Pathology and Cytopathology. Also included in it are ancillary studies such as, immunohistochemistry, electron microscopy and molecular pathology.
2) Clinical Pathology: Includes Clinical Chemistry, Microbiology, Hematology, Blood Banking & Immunology

Residency: Pathology residency in the USA is a 4 or 5 year training program after medical graduation. Residency in combined anatomic and clinical pathology is 4 years plus a credentialing year while in separate anatomic or clinical pathology is 3 years plus one. The credentialing year is very loosely defined and can be fulfilled by a year of internship (recommended), research or subspecialty training. In Canada there is no separate clinical pathology, instead there is an anatomic and a general (anatomic plus clinical) pathology training. A list of USA and Canadian training programs is available at ICPI website. An yearly updated directory of programs could also be ordered there. Another searchable list of pathology programs in USA is available at AMA FREIDA. It provides summary, contact information and links to individual programs.

Subspecialties: Subspecialties of diagnostic pathology include clinical chemistry, microbiology, blood banking and hematology in clinical pathology. While in anatomic pathology these are forensic pathology, cytopathology, pediatric pathology, transplant pathology, diagnostic electron microscopy, tissue immunopathology, and various regional pathologies (Neuro-, hemato-, gynecologic, urologic, gastrointestinal, dermato-, soft tissue, orthopedic, cardiovascular, pulmonary). The list is increasing with time. Practice of subspecialty usually requires a fellowship (1-2 year) with or without a respective board certification. For a search of USA programs use AMA FREIDA.

Academic Pathologists: These pathologists practice in a university based teaching hospital and participate in teaching, service and research in a varying proportion. A subspecialty training and/or research experience are major assets.

General Pathologists: These are jacks of all trades. They have been trained in all disciplines of pathology i.e. both anatomic and clinical pathology. They usually work in a non-academic setting and deal with everything in the laboratory including, surgical pathology, cytopathology, hematology, blood banking, microbiology, chemistry and management.

Anatomic Pathologists/Histopathologists: They have been trained in anatomic pathology ( with or without training in clinical pathology) and more importantly their practice is limited to anatomic pathology.

Surgical Pathology: A pathologist practicing surgical pathology/histopathology performs a critical role in the diagnosis and management of neoplasia or tumors. Pathologists receive biopsies from a wide variety of physicians, ranging from general practitioners, gastroenterologists, dermatologists, nephrologists to surgeons. The most important job for them is to differentiate between a benign and a malignant lesion (cancer). They also play a useful role in diagnosing a variety of inflammatory and degenerative diseases. After initial diagnosis on biopsies, the pathologist provides useful data on surgically removed specimens (such as breast, bowel, uterus etc.containing malignant tumors ) which guide the surgeon and the oncologist in planning further treatment. They also play an important role in prevention of cancers by screening for the precancerous lesions. These include dysplasia/atypia on gastrointestinal, gynecologic and skin biopsies. By helping clinicians in discovering these lesions early, before they have the full malignant potential, a high cure rate could be achieved.

Cytopathology: A branch of anatomic pathology based on morphology (shape, size, staining) of individual cells dissociated from the tissues. The cells get dissociated from the tissues naturally (exfoliate) and may be sampled from the sputum, body fluids and lining of the organs e.g. cervix (PAP smear) or gastrointestinal tract. The other way of sampling is through fine needle aspiration (FNA) where cells are artificially dissociated from the tissues and collected with the help of a fine needle. Cytopathology is extremely useful in screening and diagnosing malignant diseases (cancers).

Autopsy Pathology: It involves the external and internal examination of a human body after the death by a pathologist. Gross and microscopic examination of organs & tissues are performed after a review of medical history. These are supported by microbiological studies in appropriate cases and chemical & toxicological examinations in forensic cases. A provisional anatomic diagnosis is released within 24-48 hours after the gross examination only and a final anatomic diagnosis along with clinico-pathological correlation after completion of all studies. The most important task is to identify the cause of death.

Forensic Pathology: A division of pathology which involves investigating into the cause and manner of death. Cause of death could be a disease or a fatal event while the manner of death signifies whether the disease or the event occurred naturally, accidentally or through suicide or homicide. Practice of forensic pathology requires residency training in anatomic pathology plus additional training (fellowship) in forensic pathology.

Clinical Pathologist: Practices clinical pathology which is one of the two major branches of diagnostic pathology. This term (clinical pathology) is particularly used in the USA and includes divisions of chemistry, microbiology, hematology, immunology and blood banking. Few pathologists choose to practice general clinical pathology. Instead, they would get sub-specialty training in one of the divisions (such as hematology or blood banking ) and limit their practice to that field. Many laboratories have PhDs incharge of chemistry and microbiology laboratories.

Clinical Chemistry: This division of clinical pathology involves biochemical analysis performed on human samples (blood, fluids, tissues) outside the body (in vitro). There is a long list of substances which could be assayed including sugars, lipids, proteins, antibodies, enzymes, hormones, vitamins, metals, electrolytes etc. A wide variety of methods are employed, such as spectrophotometry, fluorometry, enzyme kinetics, enzyme immunoassay (EIA), electrophoresis, flame photometry, ion selective electrodes, HPLC, gas chromatography, mass spectrometry, and atomic absorption spectrometry. Most instruments are however almost completely automated.

Hematology: Blood cell counts & morphology and clotting of blood are the two main areas which are analyzed in this division. Pathologists specialized in this field i.e hematopathologists also examine bone marrow and lymph node biopsies. They are expert in the field of anemia, leukemia and lymphomas.

Blood Banking: A division of clinical pathology that deals with collection, storage, compatibility and safety of blood and its various components for the purpose of human transfusion. The components include packed RBCs, WBCs, platelets, fresh frozen plasma, albumin, cryoprecipitate, clotting factors and immunoglobulins. Specific tasks include blood collection after donor screening; chemical and serologic tests to exclude transmission of infective diseases; component preparation and proper storage; blood typing, screening for antibodies against red cells and compatibility testing; immunophenotyping of blood cells; investigation into transfusion reactions; inventory maintenance; apheresis & plasmapheresis.

Microbiology: A division of clinical pathology involved in isolation, culture, and identification, of micro-organisms (parasites, fungi, bacteria & viruses) in biological samples. In addition to conventional microscopic and biochemical methods for identification, DNA/RNA based assays (including PCR) and immunoassays are increasingly being used. Subdivisions include bacteriology, parasitology, mycology (fungi) and virology.

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Pathologists' Assistant: A pathologists' assistant helps pathologist in performing autopsies (opening of the body and dissection of the organs) and handling the surgical specimens (gross examination and dissection, submission of sections, photograph taking, dictation). A bachelor degree in a biological science with further training or a masters degree in a specialized program is usually required. Click here for a list of the programs in the USA through NAACLS which is responsible for accreditation.. For further details please contact American Association of Pathologists' Assistants.

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Medical Laboratory Science/Technology:

Medical laboratory technologists and technicians perform most of the work within the medical laboratories. Within this group there are:

Medical Technologists/ Clinical laboratory Scientists: They are responsible for performing analytical tests on biological samples. They are also responsible for quality control and maintenance of precision and accuracy. They play an important role in developing and establishing procedures for collecting, processing, and analyzing biological specimens. Usually a baccalaureate degree from a medical laboratory sciences program is required. Degree holders in other biological sciences will require further training.

Medical Laboratory Technicians: They are responsible for performing analytical tests on biological samples. Usually an associate degree from a medical laboratory sciences program is required.

Histotechnologists & technicians: Work in anatomic pathology/histopathology laboratory and are responsible for preparing tissue specimens for microscopic examinations and performing frozen section procedures. A degree or associate degree is required.

Cytotechnologists: They are responsible for screening the cytology smears, most of which are PAP smears. They perform tedious job of identifying and marking the cells suspicious for carcinoma, dysplasia or other abnormalities. These smears are then assessed by a pathologist. The cytotechnologists thus play a very important role in prevention and diagnosis of cancers. A training in cytotechnology is required.

Phlebotomists: They are responsible for collecting blood specimens for analysis.

Cytogenetic Technologists: Perform culture of human cells and evaluate abnormalities in the number and morphology of chromosome.

Click here for a search of programs in the USA through NAACLS which is accrediting agency in the USA for clinical laboratory sciences. For further information also visit two of the certifying agencies in the USA; Board of Registry - ASCP and NCA

In Canada CSMLS is the certifying body and professional association.

For other countries here is a list of national societies for medical laboratory sciences which are IAMLT Members

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