Correspondence:
Arie Perry, MD Professor of Pathology and Neurological Surgery Director of Neuropathology and Vice Chair of Pathology University of California, San Francisco (UCSF) Department of Pathology, Division of Neuropathology 505 Parnassus Avenue, #M551, Box# 0102 San Francisco, CA 94143 Ph: 415‐476‐5236 or 415‐476‐4961 Fax: 415‐476‐7963 E‐mail: Arie.Perry@ucsf.edu Web: http://pathology.ucsf.edu/about/faculty/pathology‐aperry.html
Dear Reader,
At the risk of starting out like a bad mystery novel, it was a dark and foggy night in San Francisco. I was working late, awaiting a frozen section. Suddenly and with little warning, the gentle hum of my incandescent computer screen was interrupted by an all too familiar notification: an incoming e‐mail. It was an overseas message from Ruth, our senior production editor informing me that once again, the Dear Reader deadline had caught me completely off guard! Oh no . . . What profound words of enlightenment should I impart? What entertaining (I use this word loosely) reflections should I share? Unfortunately, I'm not feeling terribly enlightened at this hour and the assignment is already past due, so I'm afraid that semi‐coherent musings will have to do, perhaps with an occasional more serious note thrown in periodically for good measure.
By the title of this editorial, you probably surmise that I've long been a fan of the television show, Star Trek and its large screen film derivations. Nonetheless, I can attest to the fact that in this regard, I'm merely an amateur Trekkie! I personally relate most closely to Mr. Spock (though Captain Picard is pretty darn cool too), with his devotion to logic and constant bewilderment at man's capacity for irrational behavior. Nevertheless, I've never once attended a single Trekkie convention or dressed up as a Vulcan, Klingon, or any other of the multitude of colorful options.
More in keeping with the tongue in cheek title above, I've been thinking a great deal lately about the challenges of modern Neuropathology training, no doubt in part, a reflection of my recent new post as a fellowship director in a program that is up for reaccreditation in less than a year! What in the world was I thinking? Are the words “bureaucracy” and “endless paperwork” coming to mind about now? Nonetheless, it is a critically important issue and one that our professional societies have been feverishly re‐exploring recently. We are in essence a very small group of people in an ever expanding and increasingly complex specialty. Our trainees represent the future of our field and if it is to survive, we must prepare them for an excitingly diverse, but quickly changing landscape. What was once a relatively simple apprenticeship between a mentor and a fellow is now encumbered by complex measurements of training adequacy, mandatory recertification, quality assurance/quality improvement, program information forms (PIFs), rotation goals and objectives, graduate medical education committees, residency review committees, internal and external program inspections, 360 degree fellow and faculty evaluations, and the list goes on and on. How in the world did we ever get by without assessing the six core competencies in the old days? Is the fellow getting adequate exposure to forensic neuropathology? How about neurodegenerative cases, nerve and muscle, pediatrics/developmental, and molecular diagnostics? How many conferences do the fellows attend, what are the educational resources, and do they have adequate opportunities to present locally and at national meetings? Are our fellows involved in hospital or departmental committees? In our program, like most, our fellows are literally pulled in a dozen different directions every day. There truly are so many educational opportunities (not to mention clinical responsibilities), that it's hard to reach the right balance. At UCSF, we recently came to the conclusion that we now need a second fellow each year in order for them to get the most of available opportunities. Wish us luck as we journey through this difficult but interesting challenge! I suspect that many of you out there are facing similar issues.
What's that you say? . . . the frozen section? Oh yeah . . . it was pretty interesting. The poor patient was taken to the OR emergently for acute loss of vision from a rapidly expanding, large sellar and intranasal mass. I think it's a pituitary adenoma undergoing apoplexy, but I'll have to wait for the permanents to be sure.
Arie Perry, MD