|Number 1 2001||
Message from the President
It is that time of year again when our division moves up a gear in preparation for our next scientific meeting - our 28th Annual Scientific Meeting will again be held at the Convention Centre on Darling Harbour from June 1 - 3, 2001. At the outset, I should like to thank the small number of registrants at this year's meeting who completed the Meeting Evaluation Questionnaires.
We value the comments received which included not only bouquets, but also a few brick bats - we will certainly take on board the feedback and endeavour to improve wherever we can. Such feedback is vital for the continuing improvement of our ASMs. While it is pleasing to note that most comments were overwhelmingly positive and confirmatory of the successful approach to our meetings in recent years, there is always room for improvement.
I exhort all future registrants to fill out the evaluation questionnaires for it is only through such comment that we can continue to fine tune our meetings. As foreshadowed at this year's meeting, there will be a change in the format for the Friday programme next year to enable registrants to attend more of the Specialty Club Meetings. We are fortunate in having a band of enthusiastic convenors of a large number of high quality specialty conferences each year, but the compression of these sessions into an afternoon has limited registrants to attending only a few of these - this has been one of the issues of concern raised by our membership. Next year the Specialty Club Meetings will be spread through the entire day, much along the lines of the US/Canadian IAP meetings, and the day will end with a Plenary Lecture to be given by a high profile speaker, either from within our Division, or from elsewhere.
The "approach to" lectures normally held on the Friday morning can be incorporated into the Specialty Club Meetings at the discretion of the Convenors, along with slide seminars etc. It is likely that next year there will be two additional Specialty Club Meetings dealing with breast pathology and neuropathology, bringing the total number of sessions to 14! Next year's two systems to be covered by our overseas speakers are Breast and Lymph Node pathology - these serendipidously happened to be the two popular future topics suggested by several people in their meeting evaluation questionnaires this year, indicating that the time is right to revisit these systems.
We have secured two outstanding overseas speakers for next year's programme. Dr. Stuart Schnitt is one of today's foremost breast pathologists and an excellent lecturer. Many of us will already have had the pleasure of listening to his presentations. He is Associate Professor of Pathology at Harvard Medical School, and holds several hospital appointments including the Associate Directorship at the Beth Israel Deaconess Medical Centre, and he is the Director of the Dana Farber/Harvard Cancer Centre Human Pathology Core Facility for Breast Cancer. He is a vigorous researcher in the field of breast diseases, and has particular expertise in breast pathology in needle core biopsies and the role of HER2/neu protein expression in breast cancer. Dr Schnitt will deliver two lectures, and he will also conduct a slide seminar. The lecture titles are "Benign Breast Disease and Breast Cancer Risk: Morphology and Beyond" and "Ductal Carcinoma In Situ: Factors to Consider in Selecting Treatment Options". The session on breast cancer will be further enhanced with a lecture to be given by our own Associate Professor Michael Bilous, Director of Tissue Pathology at the Institute of Clinical Pathology and Medical Research at Westmead Hospital.
Above: Marsali Newman, Jodi White, Yu-Wei Goh and Bruce Latham - all from Perth, at the June, 2000 meeting.
Top: Siva Das Thuraisingham (Gribble's Lab at Ipoh, Malaysia), Tom Simon (Whyalla), John Roberts (Albury) at the June 2000 Meeting
Michael is well-known to us as an outstanding breast pathologist who has made a large contribution to national breast screening programmes, and for his commitment to developing best practice in breast pathology. He will present a topical lecture provisionally entitled "The Current Status of HER2 testing in Breast Cancer'. This promises to be a stimulating day of breast pathology. Our second overseas guest speaker also needs no introduction. Dr Lawrence Weiss hails from the City of Hope National Medical Centre in Duarte, California, where he is Chairman of Pathology, and he is also the Chief Medical Director of the US Laboratories Anatomic Pathology Reference Laboratory at Irvine, CA. Dr Weiss is world-reknowned for his expertise in general surgical pathology, but more specifically for his distinguished career as a haematopathologist, and one who has contributed enormously to our understanding of Hodgkin's disease. He is a prolific writer and an indefatigable, enthusiastic lecturer. Dr. Weiss honours our Division by accepting the invitation to deliver the inaugural Plenary Lecture in 2001, provisionally entitled "The Molecular Biology of Hodgkin's Disease". His two other lectures will be "Problems in the Diagnosis of Hodgkin's Disease" and "The Immunohistochemistry of Haematolymphoid Disorders".
These will be followed by a slide seminar on Lymph Node pathology. I hope this brief summary will whet your appetites for what promises to be an exciting and instructive 3 days in June. The poster presentations are an integral part of the success of our meetings. It was very pleasing to see the marked increase in the number of posters at ASM 2000, all of which were of outstanding quality. My thanks go to Professor Soon Lee for convening the very successful poster presentations, and to his fellow-judges for their time in assessing the posters. It was clear from this year's posters that entries came from widely diverse sources and included both research conducted primarily by registrars, and work undertaken by more senior investigators including consultants or those engaged in research towards a higher degree. To ensure that the assessment process was fair to all entrants, and that posters were judged on an equal footing, it was decided to award two first prizes.
Next year the guidelines for poster entries, which are currently being re-drafted, will require poster entrants to choose between two categories of entry. Registrars should therefore be assured that their original work will be judged against like work by other registrars. Please encourage and support registrars to prepare poster presentations - their work is highly valued and should be shared at scientific fora such as our ASMs. Preparation for the International Congress to be held in Brisbane in 2004 continues on track under the able guidance of Professor Robin Cooke and his colleagues. Several members from our Division were able to attend the International Congress in Nagoya this year, and no doubt valuable insights were obtained into the conduct of the international congress which should prove useful in planning for 2004.
There is considerable expense for the host Division in organising such a Congress. Several pathology firms have already made valuable financial contributions to the Division towards the cost of running the Congress, and I would hope that other Australian and New Zealand pathology firms might make similar contributions. Our Division will be on show to the rest of the international pathology community, and we all have an interest in ensuring that we host the best Congress possible. On the housekeeping front, we should have credit card facilities available soon, certainly in time for registration for this year's ASM, and for the payment of annual subscriptions. I hope to see as many of you as possible at the ASM which is shaping up to be an exciting meeting.
By Andrew Tie, Wellington. R.C.P.A. Council Representative for New Zealand
Note - Part II Candidates RCPA Slide Examination
The CAPE programme consists of ten discs each with fifteen cases. It is "tailor-made" as 10 practice exams for Part 2. Do each one under examination conditions, time yourself and then ask someone to check your written answers to see whether your reports have been done according to the instructions for candidates which accompany the "real" examination slides.
This is an innovative CD-ROM based continuing education tool for histopathologists. It springs from Professor Robin Cooke's long involvement with the APESE programme. The format has logistical advantages, with no limit on number of copies, obviating circulated glass slide sets, and minimising ethical considerations about patient material.
The format is simple and user friendly, and I particularly liked the ability to scan with the mouse arrow on the opening page of each case. Macroscopic images (not conveniently included with glass slide sets) are available. The image quality is good, at least to my admittedly uncritical eye. The viewer is restricted to the recorded illumination intensity, but the clarity is acceptable, and presumably is capable of further improvement.
Andrew Tie (Wellington), Martin Whitehead (Christchurch) at the IAP Meeting in June 2000
There is some limitation in examining nuclear detail. The obvious difference in interpretation from a glass slide format is that salient features are unavoidably presented, and secondary features may not be, because of memory limitations or complexity, so that interpretative skill tested is narrower than in real life, or with glass slides. This is not to deny the usefulness or relevance of the program, but it does result in a rather different assessment from the APESE program, which it supercedes.
Presumably with increasing sophistication and computer power, it may be possible to alter such a program to allow selection of parts of images at each magnification for further enlargement, with a "tile" layout, although this may require unrealistic storage capacity, but would approximate a glass slide assessment more realistically. With mandated participation in CME in New Zealand imminent and compulsary in NSW from 2001, this kind of program has attractions because of its relative simplicity. Performance data, such as comparisons with contributors' diagnoses, could be easily recorded and filed. Compliance with recertification requirements is quite an issue for already overworked pathologists.
This program takes a novel approach, and since all case circulation programmes are artificial in one sense or another, the limitations of an electronic format must be weighed against questions of reproducibility, cost and logistical simplicity. The programme could be website-based, which would eliminate even the circulation of CDs, and could be tailored to a points-based CME programme, although New Zealand's present requirements in pathology are time-based for recertification, whereby a minimum annual recorded participation of 100 hours in CPDP is required. Participation in external Q.A. programmes will also be required. It seems doubtful that electronic images will replace glass slides in external Q.A. programmes in the near future, but who knows?
For further information contact Mr Rob Watts at KBS. Ph.3869 0994 / Fax 3269 6444 / Email email@example.com Editor
Our Gambian Connection
From PathCentre, Western Australia
In March 1992, PathCentre's C.E.O., Dr. Keith Shilkin (then Head of Histopathology at SCGH) received a letter from France, which was to alter dramatically the life of a young Gambian doctor, Dr Omar Sam. The letter was from Professor Bruce Armstrong, the Deputy Director of the World Health Organisation's International Agency for Research on Cancer (Professor Armstrong was at one time W.A.'s Commissioner for Health). One of Professor Armstrong's tasks was to oversee a major research project in The Republic of The Gambia, evaluating the effectiveness of vaccination against the Hepatitis B virus in the prevention of primary liver cell cancer (hepatocellular carcinoma Ð HCC).
The Gambia unfortunately boasts one of the world's highest incidence rates of HCC, which is known to be causally associated with Hepatitis B virus infection of the liver. The Gambia Hepatitis Intervention Study as it is known, is a non-randomised controlled trial of 124,000 Gambian children who are being followed for up to 40 years, and who will be monitored for the development of HCC throughout their lives. The proper conduct of this study requires accurate histopathological diagnosis of HCC and accurate cancer registration facilities, and herein was the WHO's and The Gambia's dilemma.
The pathology services at the Royal Victoria Hospital in Banjul, Gambia's capital, were being provided by a retired former head of pathology, and there were no trained pathologists in the nation.Professor Armstrong saw the need to bolster Gambia's pathology services, and sought Dr. Shilkin's assistance to train a young Gambian doctor in pathology. The Gambian Health Department had identified Dr. Sam as a willing and suitable person for this task. Dr. Shilkin readily accepted Prof. Armstrong's proposition and determined that The Gambia would be best served by having Dr. Sam formally enrolled into the Royal College of Pathologists of Australasia (RCPA) five year Fellowship training programme. Thus, on the 28th March 1993, Dr. Sam, supported by a W.H.O. Fellowship, was warmly welcomed into the SCGH Histopathology Department, and later PathCentre, as a pathology Registrar and a registered trainee of the RCPA.
Needless to say there was the inevitable culture shock over the course of the first few weeks. Dr. Sam hailed from the smallest country on the African continent, with a population of some 1.3 million people, vastly different from the wide open spaces of W.A. with its different people and customs. The Gambia occupies a mere 11,300 sq km in West Africa, and is surrounded by Senegal on all sides except for its free western border with the Atlantic Ocean. In fact, The Gambia's terrain consists of The Gambia River's flood plain. The Gambia flanks the lower Gambian River for 320km inland from its Atlantic coast, and is only about 50km at its widest. Dr. Sam was a graduate of the College of Medicine at the University of Calabar in Nigeria, where he graduated in 1987, and was the recipient of the prestigious Chief Dr. E.L. Iwuanyanwu Prize for the best all round graduating student. He was embarked on a surgical career in Banjul, when his career path was radically altered in response to his Government's call to undertake specialist training in pathology.
Once in Perth, Dr. Sam threw himself wholeheartedly into his pathology training. It was soon evident that his Government had made an excellent choice in selecting him for this onerous task. He was highly intelligent and extremely capable, and he very quickly demonstrated an aptitude for the speciality of Anatomical Pathology. His training programme was identical to that of the local pathology registrars whom he joined as an integral team member. It was not long before he came to understand the local vernacular, and respectful informality soon replaced the formality and hierarchy-conscious diffidence which was apparent on his arrival Ð his "ozzification' was remarkably quick, and his sense of humour developed a distinctive Australian flavour. The next six years were to test his resilience and dedication. The original 5 years of anticipated training were extended at the request of his Government so that he could gain some experience in Haematology, which he did in Dr. Erber's Haematology Department at PathCentre. Being removed from family and friends for so long was no easy matter, and bouts of homesickness were inevitable. Financially he was also under great strain, as he was self-funded on a meagre WHO stipend. Add to this the rigours and demands of the training programme, and the service commitment to the Pathology Department, then the enormity of his effort can be well-appreciated. Despite these vicissitudes, he always went about his task with enthusiasm, diligence, and with a quiet dignity which was his hallmark.
He successfully completed all the RCPA's requirements by formal examinations, the last one successfully passed in early July 1999. En route, he won the first prize for his poster presentation at the 1999 Annual Scientific Meeting of the Australasian Division of the International Academy of Pathology, where he presented some of his original research carried out in PathCentre's Anatomical Pathology and Haematology Departments. After what seemed a relatively short time for us, but must at times have seemed an eternity to Dr. Sam, he finally came to the end of a long and hard road, an achievement which cannot be overstated and which we salute warmly. On the way Dr. Sam made many friends and endeared himself to all in the Department.
He was a fine ambassador for his country. He is the first doctor from an overseas country to have successfully attained the RCPA's Fellowship by undergoing the full training programme in W.A., although many others from overseas have spent part of their training time in our Department. The Gambia now has the services of a world-class diagnostic pathologist. Through Dr. Sam the WHO and The Gambia will now be able to properly evaluate the efficacy of their Hepatitis B vaccination programme. More importantly, Dr. Sam will play a major role in the future development and direction of pathology services in The Gambia. His time in Perth was really but a small step along a much longer and difficult road which he will travel in the years ahead.
He will need the wholehearted support of his Government, and the continued support of the W.H.O. through it's agencies, to ensure that his laboratory is equipped and staffed at the appropriate level to provide the best possible service to The Gambian people. We can all feel justifiably proud that we have been able to play a small part in this very important initiative. We hope to stay in contact with Dr. Sam in ways additional to his continuing to belong to the RCPA. Dr. Sam left Perth in early July 1999 to return to The Gambia, accompanied by the very best wishes of his friends and colleagues at PathCentre, where he will be missed.His future achievements will be followed with close interest by us all, and we know he will make a significant difference in the provision of health services to The Gambian people.
Dominic V. Spagnolo Clinical Director, Anatomical Pathology, PathCentre.
Report from Dr Omar Sam
The position I occupy here in the Gambia, a tiny West African Country, and what I do, is a reflection of my postgraduate training at PathCentre in Perth, Western Australia. My training was in histopathology in Dr Keith Shilkin's and then Dr Dominic Spagnolo's department, but I was extremely lucky for the opportunity to spend time in Haematology with Dr Wendy Erber and in Forensic Pathology with Dr. Clive Cooke. Time seemed to take on a different dimension while I was in Perth. There were periods, even during my last year, when I felt that my training would never come to an end, yet at other times everything seemed to be moving too fast!
At the beginning of the programme I had the option of "on the job learning" and gaining experience in identifying liver tissue and making a diagnosis of hepatocellular carcinoma which is the main reason why I went to Australia, through an arrangement initiated by Dr. Bruce Armstrong, on behalf of the International Agency for Research in Cancer, Lyons. The Agency needed someone to evaluate the effectiveness of hepatitis B vaccination in reducing the incidence of long term complications of the virus. Though this option was attractive as I would have had more time to laze around the beautiful beaches of Perth, I wanted to become a histopathologist, going through the whole training programme of the College like any other trainee.
The Department of Anatomical Pathology (AP) at The Western Australian Centre for Pathology and Medical Research (PathCentre) provided the appropriate environment for my training. There was so much to learn and above all the staff were friendly and welcoming. The first thing that attracted me was the casual nature in which staff related to each other irrespective of their position or status. It took me some time getting used to the informality and telling jokes at tea-time sitting next to Greg Sterrett, Dominic Spagnolo, and/or Keith Shilkin, as I was more used to a stratified hierarchy with due respect to, and restricted communication with seniors. Only Consultants enjoyed Consultants' jokes at home! Amidst that "laid-back" attitude to interpersonal relationships, I discovered a high level of thoroughness and competence in a department that was, although friendly , not ready to accommodate lazy registrars. As I wanted to be treated like any other registrar, it was a challenge for me to deliver equally, if not more. The high calibre of the other registrars in the department kept me on my toes at all times.
The training programme offered by the department was comprehensive, and I was exposed to all the various aspects of Anatomical Pathology. Slide interpretation with clinicopathological correlation was always emphasised and this has stood me in good stead since my return to the Gambia. Registrars in Perth are fortunate in having the opportunity to rotate through six AP departments whose work derives from the length and breadth of Western Australia. The three and eight months fulltime attachments I did in the departments of Forensic Pathology and Haematology respectively, were very rewarding and useful for my daily work here. As the head of the National Laboratory Services, I oversee work in clinical chemistry and microbiology, and I am actively involved in haematology and blood transfusion. The first ever National Blood Transfusion Policy was drafted by me with the help of a WHO technical expert, and I am involved in developing a network for monitoring antibiotic sensitivity patterns within the subregion, to mention a few of my tasks. I attend short training courses wherever possible to prepare for such projects.
Administrative work is the most distracting, if not annoying aspect of my work here. It has also been difficult adjusting to not being able to employ at the stroke of a pen, all the ancillary diagnostic modalities which were readily available in Perth Ð it certainly makes one appreciate even more just how critical proper morphological assessment is! The driving force I have in the Gambia is my commitment to make a change in the delivery of laboratory services in general pathology, and histopathology in particular. I am working with two other histopathologists, Professor Rafael Sorhegui and Dr. Rafael Rizo who have had 25yrs and 17yrs experience respectively in Cuba, and who provide technical assistance to the Gambia. We share work within the unit and it is their presence that allows me to attend to non-histopathology activities. Both have developed the utmost respect for the calibre of pathology training in Australia. Because of the large scope of the work around me it is difficult and too early to assess my achievements to date. In the major referral hospital, the Royal Victoria Hospital, where my office is located, we have improved the quality and volume of biopsy reports, commenced weekly departmental and monthly hospital clinicopathological meetings, and the clinicians are increasingly using our services.
One of the challenges I face is to convince relatives, and surprisingly some clinicians, of the value of post-mortem examinations. These have increased in number since my return, but the majority of post-mortems remain medicolegal cases. One of my most challenging tasks in the near future is to commence a national cervical Pap smear screening programme but the support so far has been minimal. The Gambia has just opened a new University with a Faculty of Medicine and Allied Sciences and I am contributing to the teaching of Anatomy and Histology, and later will also teach pathology. After one year it has become quite clear to me just how necessary it was for me to embark on the College's training programme, in order for me to have a useful impact on our delivery of health services here, and to make a difference. The respect I have gained among my colleagues is a reflection of the quality of the training programme I undertook in Australia, for which I am very grateful. I will always have fond memories of my friends in Perth, and thanks to email, I am able to keep in close contact with them.
Professor Bernard Ackerman was the first R.C.P.A Visiting Professor to Australia. Bernie attended the I.A.P. Congress in Nagoya and gave a session on dermatopathology in his own inimitable style. Bernie made his first visit to Australia in the early 1970's.
From this time onwards many Australian pathologists took advantage of his teaching facility which involved joining his daily work reporting sessions around his multi-headed microscope. As his fame increased and as the technology improved, the number of heads on the microscope and therefore the number of postgraduate students who could attend his sessions at any one time increased.
In 1999 Bernie opened his new place of work - The Ackerman Academy of Dermatopathology - in New York. His latest multiheaded microscope is a Leica microscope which has 27 heads, pictured above in its natural configuration and also with Bernie and students. Bernie is world renowned not only for his in-house teaching, but also for his wonderful lectures and his many publications. He recently established his own publishing firm -
Gynaecological Pathology Symposium
St Vincent's Hospital, Melbourne 17 - 18 March, 2001.
Invited Speakers: P. Clement, Professor of Pathology (Vancouver), Professor A. Ostor, Professor N. Hacker, Professor S. Khoo, Dr J Scurry, Mr P. Grant, Dr R Jaworski, Dr J. Armes.
This multidisciplinary meeting will cover cervical adenocarcinoma, familial ovarian carcinoma, trophoblastic disease, borderline ovarian tumours, stromal uterine tumours and will also include a histological slide seminar.
Further details: Dr Nick Mulvany. Ph: 03 5174 0800 Fax: 03 5174 7335.
Registration: The Victoria Medical Postgraduate Foundation Inc., Level 8, Mary Aikenhead Building, St Vincent's Hospital, 41 Victoria Pde, Fitzroy, Vic. 3065. Ph: 03 9415 1177 / Fax: 03 9416 2624 /
and Opportunities in Pathology
European Congress of Pathology - European Society of Pathology
Meeting with the Pathological Society of Great Britain
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