Welcome to our fourth podcast episode! Today our guest Dr. Tristan Rutland from Australia shares some of his favorite resources for pathologists on a local level, for day-to-day use, and continual education. Listen now:
Dr. Tristan Rutland is a highly accomplished medical educator and anatomical pathologist with a strong background in teaching and training at various levels of medical education. He graduated with distinction from the University of Wollongong in 2011 and received the prestigious Konrad Muller RCPA Outstanding Teaching Award in 2020.
Dr. Rutland’s teaching experience spans from first-year medical students to final-year pathology registrars, and he’s actively involved in cross-specialty training for various registrars, including those in dermatology, surgery, and oncology. In addition to his teaching responsibilities, Dr. Rutland runs an entirely online Master of Medicine (Pathology) course and has introduced virtual pathology, which plays a crucial role in pathology education at Western Sydney University (WSU).
Dr. Rutland is currently based at Western Sydney University and Liverpool Hospital, specializing in anatomical pathology, with a specific focus on gastrointestinal pathology.
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Transcript
Jake Brown: Okay, welcome to the Ask a Pathologist podcast sponsored by Lumea and the Digital Diagnostic Summit. The idea behind this podcast is to provide good, helpful, and useful information and resources for current pathologists and pathologists in training. I am Jake Brown on the board for the Digital Diagnostic Summit and Senior Product Marketing Manager for Lumea. I want to give a warm welcome to our guest, Dr. Tristan Rutland. Dr. Rutland, it’s nice to have you on the podcast. Thanks for joining us.
Tristan Rutland: Thank you for inviting me.
Jake Brown: Yes, we’re excited to talk with you today. Before we get into our topic, do you mind taking a second to introduce yourself for the audience so we can know a little bit more about you?
Tristan Rutland: Okay, so yeah, I’m an Australian pathologist. I’ve been working for seven years now since I graduated.
I work in a place called Liverpool, which is in southwestern Sydney. It’s actually a very interesting place to work in. It’s a very multicultural sort of area as well, so we see a lot of diversity of pathology, which is really interesting as well. I also work at the University of Western Sydney, where I’m involved in the medical school there, where I train medical students, and I do pathology teaching there as well. I also have involvement in some other universities, a sort of more casual appointment as well. As you all know, I do teaching via Twitter as well, and social media, which is something I really enjoy. And my former life before any pathology, I was a pharmacist.
Jake Brown: Okay, well, that’s a wide variety of things that you are experienced in and also sound extremely busy. So we’re really grateful to have you.
Tristan Rutland: No, thank you. Thank you once again.
Jake Brown: Yes. Okay. Well, we’re excited for this topic today. We’re kind of focusing in on best tools and resources for pathologists. That’s the topic today. I’m excited to hear from you, especially with your wide variety of expertise and the things that you are doing right now.
I’m sure our audience base is going to be really excited to hear your feedback and some things that you are familiar with that they might not be.
So no further ado, I’ll just turn the time over to you and let you take center stage.
Local Resources for Pathologists
Tristan Rutland: Yeah, sure. Thank you. Well, it’s interesting. I had a when I was up to do this I had a bit of a think about you know resources as a sort of general term and um it’s interesting. I sort of had some ideas which probably weren’t, in you you know, the traditional sort of resources that we might think about and I try to break it down into different categories. So but certainly a lot of stuff will talk about in regards to online resources as well I think certainly that’s the areas that I use a lot of but one of the things that I suppose is sort of important is really going back to basics is just local resources, and I know that sounds a bit silly, but one of the things I find extremely useful as a resource is actually my clinicians. I’m heavily involved in you know multidisciplinary teaming or teams and in regards to tumor boards as well and interactive and being on site is really really useful. I find that certainly diagnostically and growing and as a pathologist, it’s really good to have contact with, you know, your oncologists, your surgeons, your radiation oncologists, so on and so forth as well.
And they can be really valuable resources, especially in diagnostic dilemmas as well. And I think people should not underestimate that as actually something that is as good as a textbook in regards to particular cases as well. So just thinking about a local sense, I think having your other colleagues in other specialties is something that I think is actually really, really useful as well.
Educational Resources for Pathologists
I suppose in regards to educational resources as well. Engaging in MDTs, what we call MDTs, tumor boards as well.
One other small thing that we do, certainly one of the tumor boards that I attend, which is we do the colorectal tumor board, is we occasionally have teaching sessions that we’ve been setting up as well.
And that’s a useful, it was actually something that was decided by the MDT. And it’s actually really useful for all the clinicians there. Not just, you know, and a lot of context, for example, as a pathologist, you know, what do my reports mean? How do they fit into the graded picture? What do the oncologists, the surgeons, you know, how does it correlate with imaging? And it just, so that’s, and that’s a bit of a local thing, but I think that’s an extremely really useful resource that I certainly, I attend all those sessions, and I find that it really helps as well. So that’s one thing that I find really, really good.
Moving up to what other things do I use on a day-to-day basis for my teaching as well.
So once again, there’s a lot of different things that we can, you know, we’ll go through them as well.
Resource Libraries
So in regards to sort of diagnostic utilities, I’m lucky, as I mentioned before, I’m part of a university and I have access to a lot of pathology textbooks online. So having access to a good resource library, and I know, unfortunately, there are many people that won’t have access to that, though there are some really good alternatives that we can discuss a little bit later. But having access to a variety of textbooks on specialist subjects is something that I do, I find extremely useful. And part of…
There’s a lot of benefits for working for the university, but one of the things is having that huge amount of being able to access, without saying any particular textbooks, because there’s a lot of really good ones out there as well, saying, I’ve got a really difficult urological case, because I’m a general anatomical pathologist that pretty much do everything, so we need to have access to it. I can go to a book and read about it as well, so that’s something that’s really, really useful as well.
And not to underestimate things like the Blue Book online, WHO, as a resource as well. I know that some people use it more than others as well. I find that I find it useful.
As a starting point for many things as well, I like to read the references behind the actual resources, especially for tricky cases. That’s one thing I would add as well in regards to resources, especially with the textbooks. They’re very well referenced, a lot of textbooks. Actually pulling out the articles and reading it for those difficult cases can be really, really useful. I find that WHO is great, it’s got a good variety, it’s obviously focused on tumour pathology, not inflammatory but another pathology, but it’s very well referenced and I find that not only reading the text but going to that is something that is extremely useful as well.
Colleagues
One thing that I should also mention, thinking about the local stuff as well, and I’m and I suppose, once again, this is just a bit of an Australia, you know, this is just for, no, it’s not necessarily for Australia, but it’s thinking in the Australian context. One thing I also find is, because as I mentioned before, as a general anatomical pathologist, being able to A, ask colleagues around our department, once again, we’re general, some people have interest areas, like I have interest areas in colorectal, other people have interest areas in lymphoma as well, so asking people about, you know, cases like that, but also not underestimating the ability to go and ask people in the local area, i .e. like New South Wales or even Australia, for second opinions, and I always find that sending cases off for second opinions to specialist pathologists is something that is really useful, and with the advent of digital pathology actually makes it a lot easier, and now, you know, once now we have, well, fortunately we don’t have as much of it in Australia as we would like but the ability now to consult people overseas in specialty areas is really, really useful. And that is a really, really useful resource in regards to backing up a diagnostic sense as well, but also learning because I find that a lot of the second opinions I get from specialist pathologists usually have really fantastic, well certainly the people that I send it to usually put a really great report together and you can learn a lot off that as well. So that’s just diverting back to the sort of local sort of feeling but that sort of like plays into that whole how technology has now adapted that we can actually use things like digital pathology and that if you have access to that, being able to get a consult within 24, 48 or whatever hours as opposed to having to pack up slides and seeing them overseas is something that is really useful.
On the flip side of that, it’s interesting that one of my mentors here as well, he still gets consults from Sri Lanka. We used to have Sri Lankan fellows who used to come to Liverpool, and they use us for second opinions as well. And they still pack the slides up in a block and send it over to us, and it’s obviously quite a long process, but that can be sped up with the advent of technology as well. So that’s certainly in regards to diagnostic areas.
Online Resources
And certainly there are things like, obviously there are great things like Pathology Outlines that are free, that are ready to access, that once again have great references behind them as well.
Obviously, they are systematised, so they have a lot of information. There is not as much as a specialist textbook on that particular subject, but I find it once again a good starting point, a great reference, and it is free, and it is curated by some pretty great people around the world.
I can’t go into a conversation about resources, about mentioning things like Twitter and KiKo and such alike, because I think that why, in a diagnostic sense from a day to day, I don’t find, you know, I find that I don’t use it as much in regards to that. I use it a lot in regards to my further education, I use it a lot for, you know, for that walking between laboratories, learning something that I didn’t know. And also, when I’ve read something or learned something, referring back to that as a resource in regards to, I remember seeing something like that. Someone wrote something about that on Twitter and being able to, or KiKo and going and actually going back and revisiting that is something that is actually very useful and actually, and free.
Hopefully, Elon doesn’t make Twitter much more inaccessible.
But, yeah, and the other thing about, I should also add a few things about Twitter and KiKo is that also if you’ve got something that is a bit tricky you haven’t seen before, having that ability to search for those cases to see what other people have had and talked about as well. So I’ve had a lot of, I’ve learned a lot from that process and though, if I have a diagnostically difficult case, it won’t be my first port of call. But if it’s something that I have heard about on Twitter, I’ll go back to it and read it as well. And once again, for people that aren’t familiar and always people that are a bit wary of social media, that’s a question I always get asked. It’s about, oh, what about peer review and accuracy? And I think it’s a really valid question. But for anyone that has been involved in Path Twitter, I think it is effectively a peer. It’s a dynamic, and KiKo as well, it’s a dynamic review process because there’s a lot of people from medical students to registrars or residents, as you would say in the US, right up to high level professors of pathology at big institutions around the world tend to weigh in on things and so you do know that most of the information, well pretty much most of the information there, you can get a feel for how accurate it is because quite often, you know, people don’t tend to put up inaccuracies. And if it does, it gets pointed out, but people are very, but that said, the people that tend to contribute, it’s funnily enough, it does seem to be of a very good quality as well, and it can generate discussion.
The Credibility of Pathology Social Media
Jake Brown: Yeah, I’ll just stop you right there because I just wanted to make sure that, I did have a couple of questions, but I’m glad you referenced that last part on social media because that was one of the questions I had because, you know, in the United States sometimes you’ll get these, they call them Monday morning quarterbacks or these armchair quarterbacks, these people that will sit on the side and claim that they know what they’re talking about.
Obviously, in the medical field, that’s a concern. So I love the way you talk about that and understand that, like, hey, obviously, you’ve got to look at the content, but pretty quickly, you can start to discern something talking about it.
Tristan Rutland: No, I think that’s a really interesting thing. And one of the things I find, see, I’m not a subspecialist. I report everything from inflammatory skin to, well, to, you know, germ cell tumors, to, you know, colorectal, to, you know, whatever. We do, the only thing I don’t do is renal biopsies, and that’s only because I just don’t have enough to, you know, I just don’t have enough time to do them. So, and the important thing from someone like myself is to realise, where is my inadvertent commerce expertise is that general trying to teach people general lesson you know for general pathology AP pathologists that are doing what I’m doing as well.
And from what and I think certainly from a lot of cases that I’ve learned from and I think that’s important to realize that this person that is teaching you what is their background, you know. So someone can say well you know this guy does to you know, he reports everything so, you know, I wouldn’t be asking me about high-tech NGS questions about you know particular things that already particular time really super rare tumors, but there are people that are certainly out there that do that which is fantastic as well. So I think that’s the importance of it and the interesting in the community people seem to really stay in their lanes with this sort of stuff as well, which is really good and for those difficult cases, the interesting thing is those people that are really good at those subspecialty areas, usually they come in and they put their piece in, they add.
And then quite often in a very, you know, add or if something’s a little bit, you know what I mean, a little not accurate, actually direct it in a really nice sort of way to, you know, to help educate people.
So I think that that’s a very good one. Monday morning quarterback. I love that. So I’m sure it’s like an armchair, sort of like what are they is a there’s a term I think as well. Another term. But yeah, no, that’s true. But I think it seems to be the culture that’s developed in this area of Twitter seems to be quite good, actually, and that’s why I’m not quite sure what in other parts of the medical Twitter world, sometimes it seems to be a little bit more wild westish.
Jake Brown: Yeah, I’m sure that I’m sure that also weeds out if you use technical terms and stuff that fellow pathologists would understand that you’re going to weed out a lot of those people anyway they’re like, I don’t know what you’re talking about, so I’m just going to leave it at that.
Tristan Rutland: Yeah, yeah, and it is good and it’s interesting and I think if you approach it with a level of humility and, you know, and realize what you can add and what you can’t add I think that you’ll be perfectly fine as well and being clearly stating and saying hey this is what I do and I know everything, does anyone else have anything else to add to this because I might be yeah so no that’s that’s really good comment actually. So yeah, I’m so I suppose.
Continuing on the whole resource, I think that’s pretty much talked about, I suppose, a lot of diagnostic stuff, the further educational, I just suppose I talked about social media as I think is a further educational sort of type modality, I think it really is that. And like I said, there’s some times that I’ve used it for, you know, reviewing difficult diagnostic cases that I’ve read somewhere else and I can, you know, sometimes I quite often put up a case that I’ve seen on Twitter that I’ve diagnosed because of Twitter.
Practice-based Guidelines
That’s quite interesting. But moving on to sort of, I suppose, more practice-based guidelines, one of the other things I think is really good that I have access to, which is free, is the various synoptic reports we’re talking more about cancer pathology here, but in regards to you know in Australia, we have the RCPA synoptic report of the ICCR which you can use as well CAP, the CAP guidelines for cancer reporting are really good at synoptic reporting as well and those are things that I really utilize and I like because A) They systematize things that we should be looking for. And they’re once again well referenced with great explanations about why you should be reporting this and what you should be reporting it for and quite often what the implications of doing what, you know, it’s why you do that and as well so I find that so those there are resources for… don’t underestimate the, you know, I have a have these things on my hotbar because I do a lot of you know we do a lot of various tumors here as well and something something I haven’t reported for for a while might come across my desk and it certainly will show the person that is a subspecial you don’t have that interest area but having that reading through it is a really, really useful way of updating your knowledge and making sure that you still you haven’t missed anything recently that’s been updated as well so there’s a couple of different ones. The UK also…
You know everyone there are a bunch of different ones there I don’t want to leave any of them out, but certainly ones I use are the ones from our college resources as well the RCPA and the CAP cancer synoptic reporting in as well. So yeah, so they are about three to four I think probably more but in general terms resources that I that I use. What other things I think about as well like it’d be interesting to see where you know obviously social media, you know it’s a relatively new thing and how it develops in regards to building you know, we’ve got threads that are coming on like that.
It would probably be, if it does, if the pathology community moves or backwards or forwards, it will probably be a similar sort of set up to Twitter in that case as well. Okay, so things like KiKo, which will have digital slides. And I should also mention things like PathPresenter as well, which has got a lot of resources on it. That’s also got, you know, question banks to test you as, you know, too, which can help you with exams as well. So, you know, there’s, and previous conferences as well. So I should mention PathPresenter. I really like that site as well.
Digital Pathology
So, and then, yeah, and then obviously there’s other things you can do and then on top of that for the last few things I suppose is just talking about digital pathology as well obviously getting digital slides up onto you know sharing digital slides is something that is some that is always going to be a bit of a difficulty unlike radiology or radiopedia where you know, there’s the amount the the size is small. Yeah, our slides are very heavy So, you know having different sort of platforms as well and PathPresenter really certainly, you know, it’s a great one as well. We use here for the university we’re using things like we use Pathomation as well. A lot of these these digital platforms have a free limit, but obviously it’s usually not a huge amount because once again we talked about the size of these slides, but in the future as we become more miniaturized and space becomes better, that is going to be something to have a online library.
And I certainly know with the RCP, sorry, I should mention this, the Royal College of Pathologists in the UK have their portal which actually they’ve built, which has got a great, once again you have to subscribe to it as well, but has huge amounts of digital pathology slides on it. And actually quite a, from my understanding, is some really good routine stuff there, which is something that is not necessarily as a resource and for learning as well, it’s not necessarily something that we all tend to focus on because of a lot of, remember a lot of the stuff we tend to put on, you know, just KiKo and Twitter and all that sort of stuff tends to be really interesting, rare stuff as well. But, you know, having actually a resource, a bank of actually normalish cases is actually something that’s really, really useful as well. So that’s the Royal College of Pathologists UK, their portal as well.
Summary
Jake Brown: Well, hey, I know we’re running up against time here, Dr. Rutland, it’s been really, really awesome to have you go through all of this information. It’s amazing to just listen and hear all the things that you have that you’re ready to spit out and offer as places and resources. It’s incredible. It’s a worldwide list of things. Thank you for sharing that.
Tristan Rutland: Sorry. Thank you. I just keep on thinking of things as I keep on going along, and that’s the whole thing. And I really hope I haven’t missed out on things because, like I said, I do apologize if I’ve missed out on anyone because, like I said, there’s a lot of really good stuff out there. We’re very lucky, actually, I think, in the world of pathology because even though we’re such a relatively small specialty.
There’s so much stuff that’s getting that we can we can now access and development that’s going into it It’s great as well And plus there seems to be a collegiality online like online that that is brilliant the fact that hey we’re doing a podcast here from across the world is great. You know, it’s I’m really happy to be involved in these things. I do really appreciate that as well.
So thank you.
Jake Brown: Yeah, yeah, no worries. In fact, I just had this thought that you know probably I mean we’ve had 30 minutes to discuss this today Which is not a lot of time, but you’ve done an incredible job, hey, round two you if you if you find some stuff and we chat and you realize that after this that there’s more than you’d like to talk about. We’d love to have you on again. So we look forward to potentially hearing more from you on additional things, but loved all the things you’ve covered today. The one that I put a star by is with what we do in my job, oftentimes I’ve seen the most successful pathologists are the ones that are really tight-knit with the clinicians and through the physician community for the patient care. So I love that you started with that. And I think that that’s an awesome thing that I wouldn’t have thought of. But when you said it, I was like, oh wait, yeah, he’s totally right on. The most successful and best patient care I’ve seen in healthcare comes from those that are willing to collaborate and work together, so. Thank you for that.
Tristan Rutland: No, like I said, and I just have to admit, I almost did physician’s training myself. And I chose pathology, but I love interacting with physicians and surgeons. And it’s one of the reasons I really like my job. I love, it’s then you feel that you’re part of that team and it can only make…
It only helps the patient, I think, and it only makes you better, so no, I’m glad you agree. So yeah, no. And that’s one of the great things about working where I work, I have to admit. Just to throw that in for my colleague, may or may not listen to this, but yeah, no, I’m lucky to work where I do.
Jake Brown: Okay. Well, hey, thank you for your time again, and we look forward to maybe an additional conversation in the future, and appreciate your time. Thank you.
We’ll talk to you later.
Tristan Rutland: Thank you, Jake. Thank you so much. Thank you. And thank you, Abby, for organizing it.
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