Histopathology Case Study: Jo Horne

Gaining the Advanced Specialist Diploma 

Dr Jo Horne BSc (Hons) MSc CSci FIBMS PGCert MHSC DHealthSci is the first IBMS member to achieve the RCPath/IBMS Histopathology Reporting qualification in Gastrointestinal Pathology. Dr Horne sat the final exam in September 2015 and was awarded the qualification in November 2015.

We asked Dr Horne some questions about her experiences of gaining the qualification, and how she feels it has benefitted her professionally. 


What motivated you to undertake the histo reporting qualification?

The qualification was a natural progression for me as I had over 10 years experience of specimen dissection, had gained the RCPath/IBMS Diploma of Expert Practice in Histological Dissection and wanted to expand my clinical role further. As part of continuous improvement I already reviewed a percentage of cases that I dissected and so reporting was not completely novel to me at the start of the formal training period.

I had always been interested in gastrointestinal and hepatobiliary pathology, and was naturally more drawn to reporting these cases with my consultant supervisors. I was also already part way through my Professional Doctorate, performing research into colorectal cancer diagnostics, and so reporting seemed a natural next step in order to develop my professional practice.


How did you find the experience of completing the histo reporting qualification?

The last three years have been the most challenging of my professional life. I already had to manage my day job as an Advanced Practitioner, whilst also coping with the significant pressure of completing my professional doctorate. The opportunity to study for the histo reporting qualification arose in the middle of this and so it became an even greater challenge to balance work and study at the same time. Fortunately, I like a challenge!

I worked long hours and studied in the evenings and at weekends. I would not have been able to manage it without the support of my colleagues, department and organisation, who encouraged me, delivered much of my training and education, and provided me with appropriate study leave.

Although I am clearly different from my medically qualified histopathologist colleagues, my department see me like a medical trainee, and I am treated and work in a similar way to any other trainee within the department. I was provided with a training plan, my own educational supervisor, an appropriate working environment and opportunities to be educated, develop myself and teach and train others.


What was the most enjoyable/interesting part of the experience?

I can honestly say that I have enjoyed all of the experience apart from the examinations! I love everything about my job, but learning to report has completely fulfilled me. I feel that I can perform the clinical role that I always dreamt of as I am now able to complete the entire cycle within histopathology, i.e. from specimen dissection to issuing a report. I have also enjoyed the increased interaction with clinical colleagues, which was very minimal before I began reporting.

I now present cases at multidisciplinary team meetings and am developing good professional relationships with people outside of the department. In many ways I have become a bridge between clinicians, consultants and the laboratory, being an easily contactable person with a strong understanding and insight into how the laboratory works.

I was also lucky enough to attend some gastrointestinal clinics during my training and I feel that these experiences really opened my eyes to the patient experience; something which is not so well appreciated if time is spent entirely within the laboratory. I also enjoyed working with other trainees from around the UK, and have developed some good contacts and friendships as a result of the training.


What was the most challenging aspect?

I have experienced numerous challenges whilst undertaking the qualification. The greatest challenge was balancing my professional responsibilities and studies, all at the same time. I sat my doctoral viva voce just six months before the final reporting exam and so the final year of training was quite stressful, with very little time for any kind of social life. However, it was worth it because I knew what the potential rewards were!

Many of the other trainees at my stage of training were in the north of the UK and I felt very isolated on the south coast at times, especially as my medically qualified trainee colleagues could support each other, as they were all based locally within the Wessex region.

Probably the biggest challenge of all has been gaining acceptance from medically qualified histopathology colleagues. Sitting an FRCPath part II equivalent examination, set to RCPath standards, is absolutely essential as I must be judged at the same level as a medically qualified histopathologist in order to be accepted as a practitioner who can safely contribute to provision of the clinical gastrointestinal histopathology service.


What kind of support would help future candidates undertaking the qualification?

To be successful, candidates need to be fully supported by their organisations, departments and colleagues. Although I did sacrifice a lot of my own time to study, an important part of my success was because of the support provided by my educational supervisors and my department. We have a clear vision for the future of our histopathology service, which we believe can be provided by a combination of appropriately qualified medical and scientific staff.

Within my department we have experienced scientists who wish to be organisational or quality managers, and we see these as clearly defined, valuable roles. However, some of us wish to follow a less traditional, and more clinical pathway, which we also see as a specific role that can contribute to, and improve service delivery. The roles and responsibilities that I deliver within my department are clinical, without also attempting to balance organisational or quality management roles. Departments need to develop a clear vision for service delivery, and to support and facilitate the appropriate pathway for those who wish to follow it.

Candidates also need to identify their ‘champion’, i.e. one or more educational supervisor who has the same vision as the department and the trainee, and who can also drive forward the training and stand together with the trainee through the difficult times - which will almost certainly arise at some point during the training. Candidates will also benefit from study leave, which I usually spent working on my portfolio or revising, and found invaluable.


How did it feel to be the first person to achieve the histo reporting qualification?

Being the first person to achieve the qualification leaves me with mixed emotions. I was obviously thrilled to pass, as I felt well prepared to sit the examination at the end of stage C. I feel incredibly proud of my achievement, especially as I gained the qualification in the same year that I achieved my doctorate. I do not feel like this is solely my success as I feel that it belongs to both myself and my educational supervisor, Dr Bryan Green. I have not been the only person to put in additional work, make sacrifices and stand up for the project during challenging times, and I cannot thank him enough.

I do feel a slight burden upon my shoulders as the first candidate ‘past the post’. I am aware that people are looking towards me, my educational supervisor and my department for guidance and for examples of what to do next in this brave new world. I also believe that it is my responsibility to drive this forward, and currently I am in a unique position to do this which is quite exciting.


How do you feel achieving the histo reporting qualification has benefited you professionally?

Achieving the qualification has benefited me in a number of ways. The most obvious is that I have gained an equivalent level qualification, albeit in a narrower area, to that of my medically qualified colleagues, which in combination with my doctorate, has provided me with the knowledge and skills to work at consultant scientist level. This will enable me to fully contribute to clinical service delivery as an independent practitioner. Achieving the qualification has also helped to develop my clinical and teaching roles and my relationships with colleagues, both within and outside of my own department.

The training has also developed my confidence and has given me the opportunity to have more of a voice on a strategic and national level, which I have always wanted. This is important because the qualification must continue to be developed and established, in much the same way that scientist-led specimen dissection is now the norm in many departments. This should become easier with time as more trainees gain the qualification in their specific disciplines.

I am excited for the future where the clinical histopathology service continues to be provided by adequately experienced and qualified practitioners. The only difference is that in the future they may either be from a medical or scientific background, and this can only be a good thing for the advancement of our profession. I am immensely proud to be at the forefront of this development.

This case study can also be found in the April 2016 issue of The Biomedical Scientist. Users must log into the website first in order to access the issue.