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Welcome to our second podcast episode! Today our guest pathologists Nicole Jackson, MD, and Brett Kurpiel, MD, each share their top three tips for pathology residency.

You can also listen on Spotify, Amazon Music, Podchaser, YouTube, and nearly everywhere else you can find a podcast. Happy listening!


Intro: Ask a Pathologist Podcast.

Abigail Diepeveen: Welcome to the Ask a Pathologist Podcast. We’re so glad to have our guests here. It is sponsored by Lumea, a digital pathology company, and the Digital Diagnostic Summit. I am Abigail Diepeveen. I work in the marketing department at Lumea and I’m also on the board for the Digital Diagnostic Summit. And we are so excited to have our two pathologist guests here to hear their take on residencies and advice for that. So Nicole, if you wouldn’t mind introducing yourself.

Nicole Jackson: Sure. Hello everyone I’m Nicole Jackson. I currently reside in Seattle, Washington, where I serve as an associate medical examiner for King County in the medical examiner’s office there. I also have a clinical professor appointment at the University of Washington in the Department of Laboratory Medicine and Pathology. Um. Outside of my day-to-day work, I have a lot of career interests in mentoring, community building, and in really pushing us forward as a field to increase diversity and exposure to the community around us as well as on social media.

Abigail Diepeveen: Thank you. And Brett.

Brett Kurpiel: Yeah. So my name is Brett Kurpiel. Hi everybody. I am currently a third-year resident at the University of Virginia in anatomic and clinical pathology. Next year I’ll be serving as Chief Resident. And then when I graduate next summer, I will be pursuing my pediatric pathology fellowship at the Children’s Hospital of Philadelphia. My main interests are in perinatal placental pathology as well as medical education.

Abigail Diepeveen: Thank you, I really appreciate it. And again, we’re so grateful that you guys were able to come here today to participate in this. Our topic today is tips for pathology residency. As an educator and then as someone who’s in a residency right now, ah, I think this would be very interesting to hear your guy’s perspective on this. And if you don’t mind starting Nicole, and then Brett, you can share. Each of you brought, I asked each of you to bring three different tips or advice that you would have for people who are early in residency, thinking about it, or about to start.

Nicole Jackson: Alright. So I guess three tips, and I think this applies wherever you are at any stage of training, um.

Keep an open mind. I think it’s good to have an idea of what you want it to be. But it’s nice to keep your options open because you never know what might interest you better. For myself, I actually started in general surgery and I went through all of medical school with my eye on being a surgeon, started residency and surgery, and then was like, oh, no, this is not what I thought, um. And I think had I gone through med school, saying, perhaps I’ll be a surgeon, but let me try, um, little samplings of all the different offerings medicine has, I think it would have served me well. And same thing in residency. I knew I wanted to be a forensic pathologist, but I was interested in a lot of things, and I still wound up doing forensics, but I think having that exposure and really caring about every single rotation has served me very well as a forensic pathologist. 

Tip two, and I heard this said when I started in pathology and it is very true. Pathology is a very small community, which means – keep those connections when you transfer between institutions. Keep in contact with your peers, with your educators, because you never know what opportunities they have, whether that’s for a job when you finish your training, whether that’s for collaborative research, you just never know. Because I know so many people and everyone seems to be connected, maybe by one to two degrees of separation. So keep those relationships strong. Um.

And then the third. I think for all of us, especially in this post-pandemic life we’re living, really focus on maintaining wellness and balance. Um. And I think it’s hard to do in training, especially in pathology where I feel the first six months to a year you’re taking in so much information and getting your feet planted. At least hold onto one thing that makes you centered and decompresses you. And then you know, as you go on and you get more comfortable, start adding things back into your life. But at least hold onto one thing.

Abigail Diepeveen: Thanks. And Brett, what would be your top three tips? And you could do more than three if you have more than three.

Brett Kurpiel: Yeah. So um, in thinking of, you know, kind of med school going full like considering careers in pathology, a tip for the med students who might be listening would be, if you think at all, you may be interested in pathology, or may want to just pursue what it would be like to be a pathologist. Please go and talk to a pathologist. We love talking to people. We love interacting with students. Um. Oftentimes people realized, like for example, Nicole, she realized you know, after she started her residency. We have some folks here who started residencies in surgery and plastic surgery who then were like, actually, I want to be a pathologist.

Um. And so if you’re interested, reach out to someone and just see what it’s like, um, a lot of times, we have some late converts that come through our department here in their fourth year who say “Actually, you know what this is really cool. I think I want to pursue a career in this.” I came into med school knowing I wanted to be a pathologist. And so I kind of kept an open mind with regard to other specialties. But ultimately, I always came back to my love of the microscope. So for med students, definitely, um, you know, keep an open mind and see if pathology is a career for you.

And then for folks starting out in residency, my second tip would be don’t be afraid to make mistakes and embrace those mistakes and learn from them. Pathology is a whole new area of medicine that you, you know, you don’t really learn that much about in medical school. You don’t learn how to gross in a specimen, or you don’t learn how to perform an autopsy. So it’s going to be a really steep learning curve. And those first few months are gonna be really hard and you’re going to make mistakes. But that is okay. It’s definitely expected. And you need to learn from those mistakes. So take it as an opportunity to learn as much as you can in that time and really grow in your knowledge, in your career, and as a person as well.

And then my last tip would be also for residents now, um, really work together as a team with your co-residents. Um, I find here at UVA we have such a really good family atmosphere. We’re always supporting each other and we have each other’s backs. And that makes life so much easier at work.

You have to take care of yourself first. Like Nicole said, staying grounded and finding something to keep yourself well. But also look out for your co-residents because they’re your family for these four years that you’re in residency and so you have to work with them. And when everyone works together and makes things, you know, work, well, it just is a better atmosphere for everyone.

Abigail Diepeveen: Yeah. Thanks. Well and a follow-up question, both of you mentioned, um, your interest in pathology in the beginning. I would love it, Nicole, if you would touch on what was the thing that made you interested in pathology once you decided surgery wasn’t for you.

Nicole Jackson: So it was actually in the OR. A lot of time spent in the OR, a lot of hours spent standing and going through adhesions and trying to not nick the bowel. But I was fortunate enough to train at Wake Forest Baptist Medical Center, which is a huge cancer center. Like we had two surgical oncology teams, very robust, um, colorectal service, and so we saw some referrals from all over the country of these insane cancers and just extreme manifestations of disease. 

And what I found myself being more interesting than the cutting was when we took the specimen out and being like, I want to look at that more and realizing that I would never get bored. Um. And for me, you know, I was drawn to surgery, because I loved anatomy using my hands.

But I really don’t think anyone works with the body and tissues more than anatomic pathologists. You know, you’re working on the gross level with your hands, your eyes, your nose sometimes. But then on the microscopic level, um, and you’re spending intimate time with that tissue for the patient, whether they are still alive and helping guide their care or in my case, the deceased. Ah. But that’s feeding into public health systems, criminal justice systems, and even back to the family with certain genetic conditions. So that was my story.

Abigail Diepeveen: Well Brett, do you mind sharing? What got you interested in pathology? You said you went into med school wanting to do it.

Brett Kurpiel: Yeah. 

Abigail Diepeveen: It’s something you don’t often hear about, right?

Brett Kurpiel: Yeah. I feel like um, a lot of times pathologists, either they come in knowing they wanna do it, or they find out really late that they want to do it. Um. So I was lucky, I, um, studied microbiology and molecular biology in undergrad. And when I was doing my, you know, shadowing hours for pre med and my applications, I had a really amazing advisor who said, “You know you love working with the microscope. You love doing molecular work. Have you ever heard of pathology?”

And I was like, “No, I don’t know what that is.”

And so she said, “Well, you, you know, you might want to find a pathologist around at the local hospital and see what they do.”

And I was very lucky that one of my friends from high school, their Dad, was a pathologist. So I got to go and shadow him for a few days. And after the first day I was like, oh, this is really cool. This is some cool stuff. I remember looking at, um, some tubular adenomas and being like, wow. So cool. Colon polyps. This is awesome. And he did a little bit of grossing. And he did a little bit of like molecular stuff. Um. And I thought this is pretty cool. And I came back a couple more days and a few more days just to hang out with him. 

And when I came to med school, I really was like, you know, I think pathology is what I want to do. But I also thought maybe infectious disease was something I wanted to do since I loved working with microbes and things like that.

But I quickly realized that histology and understanding the microanatomy of the body was what really fascinated me. And so I got to get plugged in really quickly once I started school, um, with the department of pathology here at UVA. I went here for medical school as well. And so I got to kind of get to know the department and they got to have me around. And I really just fell in love with the field.

Abigail Diepeveen: Well thanks. Thank you for sharing your perspectives on that and what drew you to the fields. Since I’m in the digital pathology field and sector, I’m very interested to know how digital pathology impacts each of you in your perspective fields in times of life. I have a specific question to start for you, Brett, about digital pathology and residency. 

For people who are thinking about specializing in digital pathology or about to go into residency. What can they expect in the residency in terms of digital pathology? Is it present? Will it be more present? Would you like it to be more present?

Brett Kurpiel: Yeah. So I will start off by saying here at UVA, we are super early in our digital pathology. We don’t really have much right now. We just acquired some hospitals, and we have some digital pathology in reading frozen sections from those hospitals. But we’re working on incorporating more digital in our true consults in our um, some of our in and out cases that we review outside pathology. But I know at some places it’s extremely robust. 

So I would say, for residents coming in, people who are applying now, you’re definitely going to encounter digital wherever you go. And so I know digital, um, has so many benefits in regards to being able to work wherever you want, being able to have quick consultations with folks. And so digital pathology is definitely coming. And it’s going to be increasing during our time here in residency.

And I’m really looking forward to seeing digital and how it grows here at UVA. I’ll probably be gone by the time it really catches on. But I know when I’m going to CHOP, they already digitize all of their slides. And so when I was up there, I got to work with a lot of digital path. And it was amazing. So digital pathology is here, it’s coming if it’s not here already. And it’s gonna be a really great opportunity to kind of revolutionize the field.

Abigail Diepeveen: Yeah. I think so, too. I recently read an interesting case study on a Leica scanner in the University of North Carolina where they just talked about not only the financial benefits, but how nice it was that every student could look at the same section of a slide. And you weren’t having to do massive blocks and lots of cuts through the block to try to get enough slides for every student and resident. And so that’s been a big benefit that they’ve seen. 

I don’t know if you have more to say on this, Nicole, since you work as a professor.

Nicole Jackson: So I do have a little bit more, just to tag team what Brett said. I think as equity is such a buzzword now, I think digital pathology will very much help bridge that, especially when you get to consults and certain hospitals, or, you know, receiving cases from, you know, when I was in Louisiana, I was in New Orleans, a major city. But we had cases out in the rural areas, right? And so we can decrease turnaround time by increasing digital pathology. So we don’t have to wait for those slides to get shipped or the tissues to get slipped. We can just do same day. And I think, you know, that advances that person’s care.

It’s not used so much in forensics. There are few offices that do, I think. Usually, they are associated with, um, big medical centers. Um. And forensics is a little slow to advance technologically. So I don’t see it being used too often in the near future. But I think it would still be good, right? 

Abigail Diepeveen: Yeah. And that’s actually the question that I have specifically for you. Is digital pathology with forensics? Um. We had a listener submit a question about forensics in digital pathology. They were wondering, especially with machine learning, if it would have any big impact on forensics. Just because of the unpredictability of it, if it’s something that could actually come into play or if it’ll just take longer than other specialties. What do you see as the future for digital pathology in forensics?

Nicole Jackson: I think it has a lower utility in forensics because so much of what we see and what we diagnose is either on gross examination, think your homicides, um. Right now we’re in a drug epidemic, it doesn’t even require microscopy, but every now and then you do. But when you’re talking about what, less than probably one percent of the cases really, really needing, histology to find the answer, um, and we’re usually publicly funded. And so it’s a big investment.

I will say, I do use some digital imaging. I do serve as a forensic pathology consultant. This big research collaborator in NYU. It’s the Sudden Unexpected Death in Childhood Research Registry Collaborative. So it’s a bunch of forensic pathologists, forensic neuropathologists, cardiovascular experts. And so we review these cases of children between the age of one and eighteen, who suddenly and unexpectedly died at home. They’ve already had their autopsies done you know, three years ago, five years ago sometimes. And so we’re reviewing the whole case, inclusive of histology, which means all those slides have been scanned. And rather than ship the slides, we use digital slides. So that’s been very helpful for the retrospective review of cases that are undetermined. But again, that’s still a very, very, very small percent of our caseload.

Abigail Diepeveen: Yeah. Well, thanks. I appreciate you guys coming on. Do you have any final advice that you would give to anyone thinking about doing a residency in pathology?

Brett Kurpiel: I would say, pathology is great. We love our jobs so much.

You know one thing I heard a lot, and Nicole you might have heard this, too is, um, as a med student people said, like, oh, well, you’re so good with people. Like what a waste that you’re going into pathology. I would hear that a lot and I would say to people who are interested in pathology, don’t let that get you down. Um. And don’t let that deter you from pathology. I’m always talking to people, whether it’s my co-residents, my attendings, or other clinicians. I’m always in contact with people. And even though I don’t often talk to patients face to face, I still am always talking to people. And you know, there are extroverted pathologists, we do exist. I promise.

Nicole Jackson: Yeah. I agree a hundred percent with what Brett said, um. And similarly, as forensic pathologists we’re talking to grieving families, we testify, talk to law enforcement, fire detectives. You have the whole staff you work with, um. So we’re talking all the time and the better you are with people period, whether they’re a patient, just interacting with people the better clinician you are.

Pathologists are clinicians. We are diagnosticians, but we also are clinicians. So that’s big. I think everyone should do a pathology rotation, whether or not you want to go into pathology or not. It gives you a greater appreciation if you’re a surgeon and what happens to that specimen. if you’re doing a frozen section, how are they working up that camera? A camera. Sorry. Tumor. Why is the turnaround time so long for this report? Um. What happens when you type in scream and type in cross? What’s the difference? What’s going on there? It just adds to you being a better physician for your patients. And then for those specifically interested in forensics or pathology in general, there’s a huge community on social media. If you just follow the hashtag #PathTwitter. I guarantee you can reach out to anyone. And they’d be more than happy to answer your questions. I think it’s an excellent resource when you’re considering programs to join.

See if their residents are there. See if they look happy, reach out to the residents, and ask them. Are they happy with their decision? Would they do it again? And I think that’s the most honest thing when we all go to interview for places, um, asking kind of behind the scenes. 

Abigail Diepeveen: I love that advice because one of the most common questions I see on forums about residences is, how can I find one with a decent work-life balance because I know I’m gonna have to work hard? But I also don’t want to suffer too much. I want to have a good life as well. So, that’s brilliant advice. I love it. Thank you so much. And thank you both for everything you do. Thanks for your time, Brett. And thanks for your time as well, Nicole. We really appreciate you guys. And we hope that you guys enjoyed listening and participating in Ask a Pathologist, and we’d love to have you guys again as guests on our podcast. So thank you so much.

Nicole Jackson: Alright. Thank you.

Brett Kurpiel: Thank you.

Abigail Diepeveen: Okay we’ll see you, We appreciate it.

Brett Kurpiel: Thank you.

Nicole Jackson: Bye


Outro: Join us next month for our next podcast. Thank you to the sponsors of our program, Lumea and the Digital Diagnostic Summit, our listeners, and our guests for making this possible and for your support.


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