How Digital Platforms are Transforming Pathology Education – Podcast

James Thackeray: Welcome to PathPulse, the Digital Diagnostic Podcast. Again, this podcast showcases pioneers, innovators, and forward-thinking individuals in the digital pathology arena who are truly making a difference in day-to-day use. And I’m James Thackeray. In today’s episode, we’re diving into a topic where our guest has truly been a trailblazer.

Sometimes we overuse those description words, but I think, in this case, we are really working with the trailblazer, especially on the social side of slides and how digital platforms are transforming pathology education. So it’s an area that we haven’t really jumped into too deeply with our past guests, and so we’re really excited.

We’re fortunate to have with us Dr. Cameron Mirza, Professor of Pathology at Michigan Medicine, the Godfrey Stobbe Professor of Pathology Education, Assistant Chair for Education, and the Director of the Division of Training Programs and Communication. Dr. Mirza, welcome to PathPulse. We couldn’t be more excited to have you with us today.

Kamran Mirza: Thank you very much, James. It’s an honor to be here.

James Thackeray: You bet. So let’s start. I always want to give you the opportunity to kind of set the stage. Give us a little bit of your background and really how you kind of got into, especially, the social media aspect to pathology education. Because I think it’s just, yeah, I’m excited to kind of learn more about it as we go through this. But if you don’t mind, why don’t you just set the stage a little bit about how this has come about.

Social media breaks classroom walls for global pathology education.

Kamran Mirza: Sure. So I think that as I was training, there are a couple of things in my background that might be relevant. One is that I literally split my life into thirds between three different continents. And so I think that I was bringing to my pathology training a view of the world, which might be a little bit different from what others have, and especially a view of the low-middle-income countries, where I did medical school in Pakistan and I was very fortunate to be there. And it was an incredible medical school, and I’m very proud of it.

But the surroundings were variable, right? And so the amount of education there was variable, the amount of health care there was variable, et cetera. So when I was in my pathology training, one thing that became pretty clear to me early on was that education is going to be a huge part of my career identity, that was my goal.

And hand-in-hand with that was that I would love for that educational identity to encompass the globe. I think that, in general, if I think about what makes me tick, it is the fact that if you have a nugget of information or education that someone has given to you or you have learned, I find that it is criminal if you take it to the grave. The whole idea of education is that it needs to be given back or expanded upon.

So I think that the idea was, well, here I am a pathologist. And I think that when I think about global education in pathology, it’s variable across the globe. And I think it’s because access to tissues is variable, access to microscopes might be variable.

And, very importantly as we think about whole-site imaging and digital pathology, the education piece in pathology actually is probably one of the most affected, positively affected things when we think about digital pathology. Because, in a way, it expands our toolkit in a way that nothing else technologically may have been able to kind of touch, like, you know, with such breadth and depth, right?

And so to bring it to social media, as I was training in pathology, what I realized was that there were groups of individuals who were teaching on platforms that, you know, went beyond the four walls of their classroom.

And I was very fortunate—I did a fellowship in medical education. It’s called the Merits Fellowship at the University of Chicago, and it’s medical education, research, innovation, teaching, and scholarship. And I was very fortunate, in that fellowship, to be exposed to how people leverage social media for education. And at the time, it was medicine, surgery. Pathology wasn’t that rampant in this use. But over the years, as I’m sure all of the listeners know, social media-based education and pathology completely, I mean, it just ramped up so quickly.

And I think that it’s incredible that it’s our window to a variety of learners, right? And so I think that it became a very obvious marriage, education and social media, for my pathology world.

James Thackeray: So exciting. What a great background. And thank you for kind of that intro.

Addressing the worldwide pathologist shortage and global health impact.

James Thackeray: Maybe let’s start more broad and then we’ll kind of narrow in, because I do think, just hearing your background, I’m fascinated to get your thoughts on where pathology in general is today and the lack thereof of true diagnostics.

And we’ll say third world countries, but the truth is we have a shortage, really, throughout the world right now when it comes to pathology. And so I just, I wondered what your thoughts are on education and how that might influence, one way or the other, pathology as a practice. Is that maybe, that, is that too broad? I don’t know.

Kamran Mirza: No, no, I don’t think it’s too broad at all. I think that it’s a great question. And I think that whether we look at low-middle-income countries or whether we look at high-income countries, when we think about medical education, pathology is a specialty that, in general, gets overlooked when it comes to medical student choice for careers. In general, it’s not the first thing people think of.

When patients go to the doctor’s office, they are thinking of a bunch of things if they get admitted. They’re thinking of the surgical care, the nursing care, maybe they think of pharmacy, but they don’t think of their diagnostics. They may know about radiology because they go into radiology departments, but they’re not familiar with how much the department of pathology is touching every single patient.

So with that background, what ends up happening is that the focus on pathology is variable, depending on if there’s a champion for pathology there, in either the execution of health care, because pathology is a huge part of it. If you don’t know what’s happening with the patient, you can’t fix them, right?

We think about global health. And in general, when you think about global health, the conversation about pathology usually doesn’t come up, at least not for the first one or two, kind of, priority items. But I would posit that without global pathology, there is no global health. How can you understand what cancers are like in sub-Saharan Africa if you don’t have a pathologist treating them, right? And so it’s super variable.

If you look at the data on the variability of how many pathologists per population are in different parts of the country, we’re very lucky in the United States that it’s a pretty high number. But there are parts of the world where there’s a pathologist for multiple millions of people. In fact, in countries like Uganda, there’s just one pathologist or two pathologists in the entire country.

So, to bring it back to the idea that those individuals are incredible superstars. They’re trying to do the pathology for a whole nation or a whole region. And therefore, will they even get time to teach the next generation? That’s one layer. Is the next generation interested in learning about pathology? That’s another layer.

So I think that, I don’t know if I’m answering your question, but basically, to think about it, the idea would be that the approach to pathology is really variable. And I think that the resources to teach pathology are variable. And the interest in pathology is variable. But all of that doesn’t detract from the fact that pathology is actually one of the biggest and most important pieces of the puzzle in figuring out somebody’s health care.

And so I think that, I’m assuming, naturally, this goes into our next phase of the conversation about how social media can kind of bridge that gap. But in general, I think that there’s variability between nations that have a low-middle-income and high-income.

And that said, one last point I’ll make is that it’s not just low-middle-income countries, because they may have areas which are shining stars of pathology excellence. I mean, that exists everywhere. It might even be in high-income countries, where you have areas that are pathology deserts. You may not have pathology laboratories in the bulk of a state in the United States. And the material is going to the academic centers in the big cities, for example. So then, if you’re a medical student from this small area, and your medical school is there, and it’s a smaller medical school, you may not even have a pathology department. There are some medical schools that don’t have a pathology department.

And so how can we raise the next generation of pathologists with that type of background? So, bottom line, it’s super variable. And could social media or could digital pathology be the equalizer here?

James Thackeray: That’s great. Thank you. Great perspective. I couldn’t, I mean, again, as a non-pathologist, but someone who’s been in this area for some time, your emphasis on the, how critical the diagnostic aspect of everything, you know, downstream, if you don’t get that right, and if you don’t have access to it, it makes it really challenging. And so maybe at some level, so this is one thing to educate pathologists or even future pathologists on—what this can look like.

And maybe it’s empowering them to help tell the story of the importance so that everybody, so others recognize it. Because I do think, at some level, it’s gotta be even a higher level that people recognize the value.

And others are, I mean, certainly therapeutic companies recognize the value, we’ve got companion diagnostics, we have all sorts of things that are coming to fruition that are based off of the diagnosis. So I think we’re getting there, it’s getting better.

Kamran Mirza: It’s getting better for sure. And maybe social media is one of the reasons it’s getting better, actually.

Digital pathology: the powerful equalizer for educational access.

James Thackeray: That’s where I wanted to go with it. So now take that, and I do believe you mentioned this, you referenced that digital pathology in general may also be an equalizer in bringing this to the world, right? To pathology diagnostics, to the world, which I think we all assume is a big, I think we get excited about that as a key piece. Tie the digital pathology to kind of the social media side of it, if you would.

And tell us just some of the approaches you’ve taken. I mean, and you can keep it to just the education side on social media, but then maybe we can tie it into digital pathology since this is a digital pathology podcast. Is that fair?

Kamran Mirza: Sure, sure. Absolutely. So, digital pathology, I guess, it’s a perfect marriage of innovation and intent with the imagination of what we can do with this. Digital pathology takes the language of pathology and makes it accessible in a way that you’re not restricted to a room and a microscope. That’s number one.

Social media breaks the walls of the classroom. And the world is your classroom. All you need is access to the internet and, obviously, electricity, and social media platforms, which are pretty much free, most of them.

So the idea would be that when you marry both of these things together, it allows you to extend—you know, your global classroom is available. So let me say a few things about social media, because I know that there are people listening who are shaking their heads already. So I would say don’t be a hater. Everything has a bad side. Social media has a bad side, 100%.

But we’re focusing only on how we can use it for good, basically. And so, at least in my opinion, if done correctly, you can use social media as a great platform for pathology education. And, you know, there are certain platforms that are now very taboo and certain ones that are more accepted, but irrespective of the platform. You can choose your poison of choice. Any platform that has a social presence or a web presence is amenable to teaching pathology because pathology is visual, and these platforms are very visual. So we’re lucky in that sense; we’re not writing hours of content to read. We’re showing an image and teaching about the image.

So, to tie it back to digital pathology, digital pathology is a visual language. And, therefore, marrying it with a visual platform makes sense. Provided, obviously, there’s no metadata, we’re taking care of HIPAA, these are de-identified things, and everything is kind of kosher.

But the idea is that that means that we’ve taken the slide from the microscope, and we’ve put it on a digital platform, and now we’ve used social media, and we can teach the world. So bottom line is I think that that’s a very powerful combination. And as social media can be used for multiple different things, between politics and geography and history, there’s so much that people are learning. You can certainly learn pathology on these platforms as well. And you can have a reach that is definitely beyond your own institution or your department.

James Thackeray: That’s great. Thank you.

PathElective and PathSIG: Free, powerful, global learning platforms.

James Thackeray: And maybe let’s elaborate on some of the digital platforms, particularly through initiatives. I mean, we talked before we got on, like the virtual pathology student interest group and path-elected facilities, the sharing of digital slides across geographical and institutional barriers. Dive into that so people can kind of say, gosh, that is…that is one way that, through social media, that’s a whole different level of education that we probably have never embarked on, or at least not in pathology. Let’s put it that way.

Kamran Mirza: Right, right. So I’ll start with PathSIG. So PathSIG is the virtual pathology student interest group. It is a student interest group for medical students and pre-health, kind of pre-medical health-related students, to understand more about pathology.

And this is similar to how you would have a pathology student interest group in your own medical school, but that’s so variable in interest. And sometimes they fail because they’re not that many people. And so we decided to create one on social media.

We were very lucky to kind of start working with the team a couple of years ago where I founded it. And these teams, these boards have taken it on. And every year, we have an incredible board. We have a new board for Virtual PathSIG. So we’re on all the platforms, social media platforms. And the job of Virtual PathSIG primarily is to think about the pathways to pathology, right. Thinking about the pipeline and encouraging individuals who are studying health-related fields to learn more about the pathology lab and medical laboratory sciences.

And so as part of that, obviously, when we encourage them, obviously, we’re going to show them data. We’re going to show them lifestyle. We’re going to show them all this stuff. And then education is a piece. And when education is a piece of it, the digital pathology becomes a part of it.

For many trainees coming up the training pathways, being digital is a way of understanding that things are modernized. You know, they go to radiology departments and they see digital things, and they go to pathology departments, and they see microscopes. And so they wonder, wow, is this cutting edge?

But digital pathology, to them, is really cutting edge. There are a few things we’ve learned about medical students. You can attract them by digital pathology, you can attract them by molecular pathology, they love to learn about autopsies. And so that’s kind of like the gateway drugs to bring them in, the gateway to the understanding of pathology.

But, directly talking about digital pathology and education, you mentioned PathElective. So PathElective is a website, a totally free website for anyone to use, that I had the great fortune to found with my co-founder, Cullen, who is currently a pathology resident, chief resident at UCLA. He was my medical student at the time we started doing this.

And this is a website that has 300,000 users now. It has over 3 million views across the world, and it’s broken up into modular sections of anatomic and clinical pathology. And many of them have digital pathology as the way our educators, and there’s over 50 faculty that volunteered their time. It’s a completely free effort. It’s amazing. I’m so proud of it. It’s like our little baby. But digital pathology is how they teach, right? Because you can do two-dimensional snapshot pathology images to teach, but then there’s another element of being able to connect to a particular platform.

We partnered with PathPresenter. They were so amazing. We kind of use their free digital library. There are other places where digital libraries exist as well. But I really wanted to give a shout-out to PathPresenter for PathElective specifically, because they were really early partners with us. And so many of our faculty use those freely available slides as the kind of foundation for their teaching. And so whether it be pediatric pathology, or gynecological pathology, or neuropathology, all of that is there.

So, in a way, what we’ve created is a pathology curriculum in the cloud. And you can access it from anywhere. And actually, from the website, we have data about where it’s accessed from. And it’s been accessed from every continent in the world other than Antarctica. So if you go to the Antarctic, please log into PathElective. And most countries in the world, except for a handful, which include some countries like Greenland, North Korea, and some countries in sub-Saharan Africa.

But other than that, every country has at least one person who’s logged in. So it’s very powerful. But it’s the same thing that we come back to, this conversation of the fact that there are web or social media-linked platforms, and there’s digital pathology, and that marriage is very powerful.

James Thackeray: That’s so exciting. And when you say, “It’s a baby,” and now it’s grown, what a great follow. It is interesting because we had a very early podcast around trying to get potential pathologists, so those that were in med school, and just trying to figure out what specialty they wanted to go into, what a great tool to kind of educate them on all the things that are happening.

And quite frankly, not only is there the need for pathology, as we know, but I do think the innovation in the, I’d love to get your feedback, but the innovation that’s gone into pathology, especially, when you look at anatomic pathology, I guess all types of pathology—in general, there’s been more advancement—I feel like in the last five or six years than in a long time prior to that. So having that education tool to say, here’s what’s changed about the specialty. You know, just curious if you agree with that.

Kamran Mirza: I mean, I love that notion, the idea that actually, within the, I’m sure there are many other facets of medicine that have modernized a lot.

But actually, pathology continuously has been bringing in ancillary studies. And a lot of people are like, “Oh, digital pathology, now AI is going to replace the pathologist.” But this isn’t the first time that pathologists have been confronted with someone saying, “XYZ will replace you.” It’s an interesting kind of dynamic.

We still have the microscope, which is, technically, a really old-school thing. I mean, it’s modernized and it’s incredible. I love my microscope. You can’t see it. It’s like right here. You know, we name them and all of them. I’m just joking. Some people name them.

But the idea is that we have this old technology, but we have brand-new technology and our ancillary toolkit from molecular studies, karyotyping studies, genetic studies, the flow cytometry studies, all the in situ hybridization… There’s so many things from special stains to special tests.

And so we’ve been modernizing, like you mentioned, definitely for the last five years, optical genome mapping. These are all things pathologists are doing or molecular pathologists are doing. And so, yes, you’re absolutely right. That social media, again, becomes the megaphone through which you can tell people, “Hey, know what? Come check us out. We’ve been modernizing. We have some cool things, bells and whistles. We’re not just like basement-dweller, anti-social, curmudgeon type of people,” which is what a lot of people think about when they think of that.

James Thackeray: But it is that convergence of the new technology with old technology. And there’s been a lot that we’ve had to build out and a lot we’ve had to learn in these last few years. But I think what’s exciting for me is that at least fundamentally, or at least, I think, as a whole, we’re excited to adopt the new technologies.

AI will refine, not replace, the pathologist’s role.

James Thackeray: So you mentioned AI. So maybe let’s tie that into the social media platform space a little bit, specific, obviously, to pathology. What role do you see? Is it currently playing a role? I mean, I can already see if you’ve got this, you know, this, you know, through PathPresenter, whatever, you can look at different slides and educate on that. You could start to access different algorithms that are obviously integrated in. What gives me the AI aspect of the social media education, if you would?

Kamran Mirza: Yeah, so I guess we can tie the AI aspect to the digital pathology, right? I mean, social media, again, would just be the megaphone. But the idea would be that large language models or GPTs and other things can have a variety of benefits in education, right? Specifically, pathology education.

One is that there might be visual parameters or patterns that large language models can pick up on that, maybe, the human eye isn’t seeing. Ultimately, that might make our job, like take away the repetitive, kind of burdensome tasks and allow us to do the higher-level, physician-linked activities of really confirming that something is abnormal or not.

From the pathology angle, though, from the diagnostic angle, that was what we can do and many more things. So I think it won’t replace us. At least, that’s my prediction. I think that it will probably refine our roles to be able to do different things. And I think that that’s going to be a welcome thing.

And I think that, in order to create a successful outcome in that, pathologists have to be involved in it. And so there shouldn’t be any sticking their heads in the sand and not thinking about it, because if pathologists don’t think about how to incorporate it, then someone else will. And you don’t want anybody else’s lack of expertise to get in the way of something being successful.

From the educator’s perspective, AI has several roles, I think. You can think about personalized education and think about an AI-built dashboard for your particular education. I mean, people have thought about content-centered education versus learner-centered education. But the truth is that many of our young learners now are self-directing their learning. And we don’t have a way to kind of figure out where all of the different pieces are in their educational journey.

But AI can holistically take a look at it and say, “You’ve been doing these few things from across the web space. This is your medical knowledge. This is your competence assessment.” And then putting it together as a personalized way of telling them that this is what you need to work on.

Similarly, we can build AIs to be Socratic. And instead of giving them answers to kind of jog their memory or nudge them into thinking a particular way, so when I imagine myself as an educator educating a group of people and discussing a case with them, and not providing them the answer, but encouraging them to think about certain things, you can prompt GPTs to be just like that. Become a Socratic AI. Act like a teacher. Do not answer the question. Nudge people in the right direction.

And so there are ways that we can, perhaps, extend our influence outside the classroom using AI as well. And again, yes, I agree. AIs can hallucinate. And we have to be very careful and all of that stuff. So I’m not denying any of those things. I just think that all of these positive things can also be leveraged.

James Thackeray: That’s great. I appreciate that.

Overcoming reluctance; embracing technology for relevance and growth.

James Thackeray: When you think about that, what are the biggest challenges when you think about the social media platform as a way of educating in this sense? What are challenges you’ve run into?

I know, maybe I’ll start by saying historically, I haven’t always associated pathology as a specialty anyway, to social media, where other specialties that I’ve been in or have worked with seem to be more aggressive in their adoption of social media. Where does pathology fit into that? Or is this pre-pathology in a lot of cases? Just walk me through some of the challenges that you faced and how you see it going forward.

Kamran Mirza: I would say that pathology is actually pretty up there with its adoption of social media. It may not have been the first specialty to do it, but I’m certain. I have no data to back this up, but I’m pretty certain that the pathology space in social media is a pretty robust space.

I think the challenges, though, are a lack of an understanding of how this can be beneficial and maybe a denial of kind of even…So I don’t think the technological challenges…I’ll start there. I don’t think that technology is a challenge, even though some people, like we’ve actually published, that the challenges to certain people are technology or worrying about HIPAA, all of those things. So there’s a paper out there.

But I think that, really, it is more about the fact that there’s a denial. I don’t even know if it’s a denial, to be honest with you. I just think that there’s a reluctance to venture outside individual comfort zones—to embrace the wide unknown of social media when it comes to pathology.

And much of that reluctance, I can understand. It’s not that it’s not unfounded. There are horrible things that happen on social media. And people are just like, “Let’s just be safe.” So I think that it takes a cohort of champions to encourage people to safely think about broadening their footprint and coming out into this world.

And so I think that, in general, reluctance is one thing, because social media, to many people, is still a bad word. And this was kind of like 10 years ago; it was a bad word. And now, with the politics built into it, as we know, global politics and national politics, that hasn’t helped. And so here we are, a group of people trying to push pathology education forward on platforms that are polarizing. People either love them or they hate them. And so I think that that’s another challenge.

So you take their reluctance and you can try and champion that, but you can’t get rid of the global politics part of it. So I think that, to me, I certainly come back to the fact that there’s a global audience, still, though, The lectures that people have given, which are recorded online that have been viewed hundreds of thousands of times, that’s a lot of people learning.

Sometimes my kids look at, if I have some random YouTube video out there, they’ll be like, “Oh my God, this has been viewed 10,000 times.” And sure, that’s not, like, a crazy viral YouTube video. But that means 10,000 people potentially came onto that platform to learn what someone was trying to teach them. And I think that that’s certainly powerful.

So, to me, that’s the balance. You know, of course, there’s reluctance. There should be appropriate reluctance. There should be caution when we use these things. Nobody should do it with recklessness. But, that said, it’s a powerful tool, and it’s up to us to kind of use it whichever way we want.

James Thackeray: That is so well said, and it ties, actually, in my mind, very directly to, or at least it’s analogous to, digital pathology in general, right? There are inherent concerns with it. There’s validations that need to be done. There’s all sorts of things that still need to be figured out when it comes to AI and the way that it works.

There’s a lot of questions, but, to your point, these platforms provide a way that, really, that there is no other way that they could scale or get that kind of information out at that level. And so I agree with you wholeheartedly: one, that it can be used for good, and they often, often, are. And it’s really more about us and how we use them than it is what others are doing, necessarily. But, so, I think as a platform, it’s such a great tool to advance pathology.

Okay, I’m going to give you kind of the final, like, give me your final thoughts on how this is going—the trajectory and where you see it. Because you’re in this early stage where you’re getting such great feedback. But if you were to, say, in five, I mean, this goes so fast, I don’t know, maybe it’s five years or ten years, what does this look like as it pertains to education through a social platform specifically for pathology?

Kamran Mirza: I think that the need will drive where this goes. If there continues to be a need for resources that surpass boundaries, like geographic boundaries or whatever it is, then this will continue to grow. So this is all free. Most of it is free. And if people are using a free thing, that means that they must like it. That’s number one.

So I think that the future is that, at least the immediate future, is that we will still continue to explore ways to leverage and maximize digital pathology using your platform of choice to be more vocal, more visible, and to really show how vital we are to health care. And I think that’s not changing anytime soon.

I think that there’ll be bumps along the way. But when we think about AI and the fact that that’s not going anywhere, I think that we have to be more, how do I say, we have to be less reluctant. We have to be less reluctant, and we have to be more open to embracing technologies that we are not familiar with in order to kind of continue to grow, right?

Growth requires a little bit of uncomfortability. And so, I would say, think outside the box and embrace certain technological advances because that is going to be needed to stay relevant.

So, bottom line is that social media and digital pathology and artificial intelligence or augmented intelligence probably, in my prediction, will continue to ramp up—not only their utility, but also how people leverage them and their ability to touch more people around the globe. And, to me, that’s a vital part of us showing how vibrant a community we are.

And I would say that it’s very important to stay relevant. So consider embracing these technologies.

James Thackeray: So well said. And the timing of this and what you’re doing, it just seems like the right convergence of timing and technology with a forward-thinking person like yourself. So thank you. We’re really excited about the work you’re doing and really appreciate that you joined us today, Dr. Mirza.

Kamran Mirza: It was my pleasure. Thank you, James.

James Thackeray: Thank you.