Diagnostic Neuropathology
The Specialty
Diagnostic Neuropathology is the pathological study of disease of the nervous system, in life and in death. Neurosurgical specimens, taken for therapeutic and sometimes purely diagnostic purposes, are at the forefront of our workload. We look at routine biopsies, smear preparations or frozen sections of samples to make intraoperative diagnoses to guide the neurosurgeon during surgery. Other specimen types include cerebrospinal fluid samples and muscle and nerve biopsies from neurologists, rheumatologists, and general medics. Ophthalmic specimens may also form part of the workload.
We work alongside neuroradiologists, neurosurgeons, neuro-oncologists, neurophysiologists, and neurosurgeons as part of multidisciplinary teams. Neuropathologists contribute to a range of regular multidisciplinary meetings to discuss the assessment and management of patients with brain and spinal tumours, muscle and nerve disease, and epilepsy.
Proteomic and genetic studies is increasingly being used in neuroscience, and neuropathologists often engage in this developing area.
Examination of postmortem specimens (whole autopsies and fixed whole brains) adds further variety. Some neuropathologists perform forensic brain examinations and act as expert witnesses in medicolegal cases. Whereas advanced autopsy training has become optional for general histopathology trainees, it remains a key component of our arsenal for diagnosis and also research.
Since neuropathologists work almost exclusively in teaching hospitals, teaching is an additional role that many of us undertake with enthusiasm and have sufficient flexibility in our working day to do. Consultant posts have rotas for covering neurosurgical specimens, but out of hours work is minimal or absent, and many of us work flexibly.
Training
National recruitment take place twice yearly. Successful applicants will enter diagnostic neuropathology training at ST3 level. Those from histopathology should have passed the fellowship of the Royal College of Pathologists (FRCPath) part 1 exam and those from neurology or neurosurgery the membership of the Royal College of Physicians (MRCP) or fellowship of the Royal College of Surgeons (FRCS) exams. Clinical “neuro-related” experience and knowledge have become mandatory.
Many trainees do some research during their training, sometimes leading to a PhD or MD. Knowledge of research techniques, particularly with respect to molecular genetics, is embedded within the curriculum. The close link of academic neuropathology departments with clinical neurosciences and basic research institutions opens unique opportunities to pursue fascinating and competitive basic and applied research and the potential to lead world-class research teams.
Important information for trainees about The Royal College of Pathologists and the organisation of training can be found on the College website.
https://www.rcpath.org/trainees/training/training-by-specialty/diagnostic-neuropathology.html
The Programme
In Yorkshire and the Humber there are two training sites, Leeds and Sheffield. These cover neuropathological services for the entire region, including remote access to Hull. The post is based in Leeds, though trainee will also spend a substantial time in Sheffield, and also have the opportunity to spend time in national centres to gain specialist skill as required by the curriculum. The training plans will be bespoke, depending on the background and entry point of the individual trainee. There is also opportunity to link closely to the general histopathology trainees in the region, as there are many areas in common, and great value in the wider peer group.
A robust process of educational supervision drives the training scheme and is based on the “Gold Guide” and sound educational principles. We are supported by our Training Programme Director (TPD). We have strong cohort of Educational Supervisors and you will be allocated a named supervisor who will guide you all the way through your training.
Trainees have the opportunity to go on a management course attend at least once during their training, which is useful both for examinations and for interviews when applying for Consultant jobs. The School also runs an in-house clinical leadership skills day, biannually for senior trainees.
After completing the Part 1 FRCPath examination, you’ll build on your knowledge and experience of neuropathological autopsies and intra-operative biopsies, and receive training in writing neuropathology reports and presenting complex cases at multi-disciplinary meetings. The FRCPath Part 2 in Neuropathology is designed to test your practical skills and understanding, and show that you can apply your expertise appropriately and safely.
Please find information on the two sites delivering this Programme below:
The Leeds Teaching Hospitals NHS Trust comprises the major hospitals of Leeds General Infirmary and St James’s University Hospital, with the pathology department being based at the latter. This department will serve as the base for most histopathology trainees throughout the five year training period, with a number of six-month rotations taking place here.
The department is completely sub-specialised, with opportunity for experience in a wide range of specialist work such as cardiothoracic pathology, haematopathology, neuropathology and paediatric pathology, as well as more common specialities. Leeds acts as a referral centre for most of North and West Yorkshire, giving an opportunity to see a large number of rare and unusual cases. Wide-ranging experience in autopsy work and cytopathology is also available.
The histopathology department functions as a series of specialist teams, the configuration of which may change with time. Team 1 does ENT, Urology, Haematopathology and Soft Tissue pathology. Team 2 does Breast, Gastrointestinal (upper) and Hepatopathology. Team 3 does Gynaecological pathology and cytopathology, and Team 4 is Dermatopathology. Ophthalmic and Neuropathology are separate.
All sites have immunohistochemistry, and molecular pathology established. The adjacent University Section of Pathology in the Division of Genomic Medicine has molecular biology, image analysis and in situ hybridisation. Electron microscopy is available.
As a teaching trust, all of the hospitals have close links to the University of Sheffield, home to Sheffield’s medical school, and Sheffield Hallam University. It is a major teaching centre for future health professionals.