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Pathologists' assistant

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A pathologists’ assistant (PA) is a physician extender whose expertise lies in gross examination of surgical specimens as well as performing forensic, medicolegal, and hospital autopsies.[1]

General Overview

PA’s work under the direct supervision of a board certified anatomical pathologist, who ultimately render a diagnosis based on the PA’s detailed gross description and/or tissue submission. Requirements to become a pathologists’ assistant include graduation from a National Accrediting Agency for Clinical Laboratory Sciences (NAACLS)[2] accredited education program and/or successfully passing the American Society for Clinical Pathology (ASCP) certification exam.[1] With ongoing changes in healthcare, increasing aging population, and a decreasing number of pathology residents, the role of the PA is in high demand due to high level of training and contribution of the overall efficiency of the pathology laboratory.[1] In addition to major responsibilities outlined above, a pathologists’ assistant may also perform following tasks: for a complete list refer to Article III, Section B of the AAPA Bylaws.

  • Frozen section for intraopertative consultation
  • Prepare tissue samples for flow cytometry, immunohistochemical (IHC) stains, genetic testing, microbiology culture, and various other laboratory evaluations
  • Gross specimen photography
  • Training PA fellows, pathology residents, and other pathology lab personnel (as needed)
  • Fulfill roles in managerial duties, instructional positions and supervisory roles
  • Research

While many PA’s are employed in hospitals, they may also gain employment in private pathology laboratories/groups, medical examiner offices, morgues, government or reference laboratories, universities, and may be self-employed and provide contract work.[1] According to a study published in Autonomic Pathology, on avg PA’s perform gross exam on 56.5% of total number of specimens, and majority are biopsies. If not performing gross examinations, they are doing things that a pathologist would do thereby saving the department money.[3]

History of Profession

The idea of physician extenders brought about in 1966 by Dr. Eugene Stead at Duke University where the first physician assistant program was established. Three years later at the same university, Chair of Pathology, Dr. Thomas Kinney implemented the first pathologists’ assistant program.[1] To date, nine accredited programs have been established across the country and Canada.[1]

Education

Each program is NAACLS accredited and collectively graduates approximately 118 students a year. As of 2010, the running total of certified pathologists’ assistants is just over 1200.[1] The programs vary in details, but are generally two-year programs both at the bachelor and masters level, and include didactic and clinical exposure. The didactic year commonly includes an education in clinical anatomy, neuroscience, physiology, histology, pathology, pathologists’ assistant (clinical correlation) specific courses, medical terminology, and interprofessional classes. Students then are placed in a clinical setting in affiliated hospitals and medical examiners offices all over the country to learn prosection and autopsy techniques hands-on.[4]

  1. Drexel University-PA Master of Science in Pathologists’ Assistant Studies
  2. Duke University-NC Master of Health Science
  3. Indiana University-IN Master of Science
  4. Quinnipiac University-CT Master of Health Science
  5. Rosalind Franklin University of Medicine and Science-IL Master of Science in Pathologists' Assistant Studies
  6. University of Maryland, Baltimore-MD Master of Science in Pathology
  7. University of Western Ontario-ON, Canada MSc in Pathology
  8. Wayne State University-MI Bachelor of Science in Pathologists' Assistant *transitioning to masters program in near future
  9. West Virginia University-WV Master of Health Science

Education and Certification

Pathologists' Assistants have been employed in pathology labs for over 40 years. Formal training programs slowly appeared (there were four nationwide in the late 1990s). The programs became NAACLS accredited beginning in the late 1990s and then the programs slowly continued their transitions from bachelor degree programs to master's programs. Prior to ASCP certification, which came about in 2005, the AAPA had a fellowship status that program trained Pathologists' Assistants or on-the-job trained (OJT) Pathologists' Assistants (who could specific coursework and 3 years of active employment) could join only based on passing a rigorous exam that parallels the current ASCP certification exam. The OJT route was eliminated at the end of 2007. Over the years, the formal training programs have slowly grown in number and most have transitioned from a Bachelor's Degree to a Master's program. Currently, there are approximately 1400 ASCP certified PAs nationwide, including a few Canadian members.[1] The professional association uniting PAs is the American Association of Pathologists' Assistants. Part of their duties as an association is to provide continuing medical education credits (CME) in order to keep members current on advances and procedures in the field that must be completed every 3 years in order to maintain ASCP certification.

References

  1. ^ a b c d e f g h [1]
  2. ^ http://naacls.org/
  3. ^ Grzybicki, Dana M.; Colleen O. Galvis; Stephen S. Raab (1999). "The Usefulness of Pathologists' Assistants". American Journal of Clinical Pathology. 112 (5): 619–626. PMID 10549248.
  4. ^ http://rosalindfranklin.edu/dnn/chp/home/CHP/PathologistsAssistant/tabid/1459/Default.aspx
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