Development of Histopathology Subspecialties in Bangladesh

Journal of Histopathology and Cytopathology
July 2018
Volume 2 n 2

Development of Histopathology Subspecialties in Bangladesh

*Kamal M

Histopathology has steadily developed in Bangladesh over years.  From a few qualified histopathologists in the early seventies, now more than 200 are working all over the country and are the main pillars of histopathology service and pathology teaching.  They are enormously contributing in surgical pathology and cytopathology services.  Majority are engaged in reporting all kinds of surgical pathology samples.  However, driven by the need of time and personal choices, some have developed interest and skill in reporting demanding specialized fields like nephropathology, gynaecological and breast pathology etc.  Some of them have received formal training in nephropathology, gynaecological pathology, breast pathology, haematolymphoid pathology etc.  They have also acquired skill through working experience, short trainings abroad, workshops and conferences and by maintaining communications with specialists abroad. Seminars and workshops are regularly being arranged by the Bangladesh Academy of Pathology (BAP), Pathology departments of  Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College, Chittagong Medical College, National Institute of Neurosciences, National Institute of Cancer Research & Hospital, Armed Forces Institute of Pathology, Kidney Foundation Hospital and other organizations.   Contribution of expatriate Bangladeshi pathologists who regularly visit Bangladesh and conduct workshops with special theme is also helping in the development of subspecialities.

The field of surgical pathology is conti­nuously evolving with the aim of correct di­agnosis, redefining many entities, changes in diagnostic criteria, detecting prognostic fac­tors,  expansion of cytopathology, incorporation of immunological and genetic studies etc.  It has now become impossible for a single person to have deeper insight in all the subspecialties. Developed countries have already adopted the concept of subspecialties in pathology.   The American Board of Pathology offers primary certification in Anatomic Pathology-Clinical Pathology. This may be combined with some of the subspecialities certifications. Those which are closely related to tissue pathology are Cytopathology, Dermatopathology,  Hematopathology, Neuropathology,Forensic Pathology, Molecular Genetic and Pediatric Pathology. The other important subspecialties are acquired through institutional training depending on the facility available at that centre. One example is the  Massachusetts General Hospital, where the existing surgical pathology subspecialities are ‘Bone and Soft Tissue Pathology, Breast Pathology, Cardiovascular Pathology, Dermatopathology, Head and Neck (ENT), Gastrointestinal Pathology, Genitourinary Pathology, Gynecologic Pathology, Hematopathology, Neuropathology, Obstetric and, Perinatal Pathology, Pulmonary Pathology, Renal Pathology, Advanced Diagnostic Modalities, Flow Cytometry, Electron Microscopy, Immunopathology, Molecular Pathology etc.’

Each of this subspecialty has a working group led by a senior pathologist, a research component, and provides a framework for collaboration and academic pursuits.  The Royal College of Pathologists, England recognizes three subspecialties of histopathology: Paediatric pathology, neuropathology or forensic pathology. For Bangladesh, we have to plan development of subspecialties in the most demanding fields at the begining as early as possible. For pathologists working in large centres, general surgical pathology combined with one or two subspecialty can be planned at the moment. Emphasis has to be given in fields where we do not have trained personnel at present. Priority can be decided by analysing patients flow.  Some  young dedicated pathologists who  want to build career in a particular  challenging subspecialty (e.g. Neuromuscular / Skin / Hematolymphoid diseases…etc.) may be given full support and encouragement.

Pathologists who are interested in certain fields may be enlisted in the subspeciality development.  The following facilities may be offered:

  • Placement and permanent posting in institutes/units of their respective interest.
  • Given access of books, journals, cases and other material of their interest in other institutes.
  • Formal training abroad.
  • Organising and percipating in workshops/seminar/interdisciplinary meetings with invited guests.
  • Participating in workshops/seminars abroad.
  • Development of specialized facilities in their laboratories and training of laboratory personnel.
  • Encourage research and publications in their subspeciality fields.

Roadmaps with implementation plans have to be developed and get approved by the societies and the stake holders. Bangladesh Academy of Pathology (BAP) along with the Health and Education ministry, and Specialist Professional Associations should cooperate and take steps to formulate and implement the roadmap accordingly.

“Setting goals is the first step in turning the invisible into the visible” -Tony Robbins (American author, entrepreneur, philanthropist and life coach).

*Mohammed Kamal, Professor of Pathology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.

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