As stated in the joint statement between the RCPath and IBMS in May 2017: “The successful candidate will work alongside medically qualified pathologists as part of an integrated reporting team and be able to dissect, independently report and present cases at multi-disciplinary team meetings in their specialism of gynaecological and/or gastro-intestinal histopathology. Additionally, these individuals will be expected to play an integral part in teaching and clinical audit as part of an overall service improvement strategy. Individuals appointed to a reporting role would be clinically responsible to the medical head of department and would be expected to participate in relevant reporting EQA schemes as required for staff undertaking histopathology reporting. This role is not a replacement for medically qualified pathologists but a key part of an integrated clinical pathology team that is able to deliver a flexible and efficient service.”

Departments who support Histopathology Reporting are aware of the challenges and opportunities and benefits. It is worth noting that we continue to receive enquiries about developing Histopathology Reporting at the College and that we have received positive feedback about existing programmes.

It is ultimately a local matter as to whether or not a department undertakes Histopathology Reporting, but the development is supported by the College, the IBMS; attracts funding from HEE and fits in to the aims of the NHS Long-Term Plan.

The exams in place for histopathology reporting are specifically for the individuals following the programme; they are set at the same standard as comparable College examinations but only in their narrow area of practice. It should be noted that appropriate slides, macroscopic pictures and written questions are used in both medical and scientist exams. The histopathology reporting programme is nominally a four-year programme (although it can take longer depending on the individual’s circumstances) with the Stage A examination taking place at the end of the first year and the Stage C examination taking place at the end of the third year. Medical trainees following the College’s histopathology curriculum are not eligible to attempt the histopathology reporting examinations and must pass the FRCPath in histopathology. Conversely, and as we have already stated, Biomedical Scientists are not eligible to attempt the FRCPath in histopathology.

All examinations, including the Stage A and Stage C examinations for the Histopathology Reporting qualification, are organised and delivered through the College examinations team using College examiners who are also involved in the delivery of the FRCPath examinations.

All College examinations are mapped to their relevant curriculum. We have recently published a new histopathology curriculum which continues to require trainees to train across the full spectrum of the specialty (with exceptions for autopsy and cervical cytology in the higher stages of training) and so the FRCPath examination reflects the curriculum. It is recognised that consultants may specialise over time but there are no plans to change the broad training requirements require for completion of postgraduate histopathology training which are aligned to the Shape of Training principles. Both the Histopathology curriculum and the FRCPath examination in Histopathology are approved by the GMC.

The requirements for entry to the histopathology reporting programme is as follows:

Applicants must be a Member or Fellow of the IBMS, a HCPC registered biomedical or clinical scientist, with at least five-years experience post-registration experience. 

Members of the IBMS are strongly recommended to have completed the IBMS Diploma of Expert Practice in Histological Dissection in the appropriate pathology before applying to undertaking the RCPath/IBMS Advanced Specialist Diploma (ASD) in Histopathology Reporting.

Additional requirements are for applicants to:  

• be working in a UK laboratory which has UKAS/CPA accreditation
• have the support of their department with a view to the candidate eventually becoming a member of the Histopathology Reporting Team
• demonstrate a commitment from their Trust to provide both an Educational Supervisor and Clinical Supervisor who will support them through the training period

We would again emphasise that Biomedical Scientists are expected to work as part of a larger team, including with medically-qualified individuals who are there to oversee cases that are either outside the scope of practice of the Biomedical Scientist or where the Biomedical Scientist requests their support. While clinical knowledge is beneficial, it does not mean that no aspect of reporting can be undertaken without a medical degree.

Individuals who have completed the histopathology reporting training programme are intended to complement the wider team in their Trust. They should not have any effect on recruitment to medical histopathology training. There is no link between the funding provided for medically qualified individuals wishing to pursue training in histopathology and the funding for Biomedical Scientists undertaking the Histopathology Reporting qualification.

There is no evidence to suggest that histopathology reporting has affected medical registrar training. Recruitment figures published by Health Education England for the last three years show 100% recruitment in histopathology and a steady increase in the numbers being recruited to year on year. This compares favourably to the round 1 fill rate in 2015 which was 85%, 87.8% in 2016, 72% in 2017 and 77% in 2018. For 2022, all 97 histopathology posts advertised through Health Education England were filled in the first round. It is worth noting that this is an increase of 16 posts from 2021, when there was also a 100% fill rate.

The College has a full programme of activities to attract medical undergraduates and Foundation doctors into pathology as a career, including histopathology. There is evidence of a growing number of histopathology training placements being available (see above) and the College’s Histopathology Workforce Survey in 2018 showed that ‘only 3% of histopathology departments said they had enough staff to meet clinical demand, and this demand continues to grow’. There is more than enough work to go around. We are also unaware of any evidence from any other specialty which run similar initiatives that the initiatives have reduced recruitment to the corresponding medical practice (for example, nurse endoscopists).

Yes, there is a curriculum, assessments and examinations with the addition of the requirement to submit a portfolio at the end of each stage that has to be submitted to the Conjoint Board for review. There is a review similar to the ARCP process to check on progress. The Conjoint Board are kept abreast of changes to the histopathology curriculum, workplace-based assessments and examinations.

There is no difference in this regard between the Histopathology training programme and the Histopathology Reporting training programme. Trainers and educational supervisors are expected to behave appropriately towards any individual that they are providing training for and ensure that the feedback they give is relevant only to the performance that they are assessing.

Biomedical Scientists are expected to cover the agreed curriculum and when they apply to join the qualification are required to nominate an educational and clinical supervisor. The educational supervisor is the person who oversees the training and development of a Biomedical Scientist and supports them to fulfil their training needs.  The clinical supervisor(s) are other supervisory colleagues that work with a candidate during their training, e.g. other members of the consultant specialty team who supervise day to day dissection and reporting. Whilst a candidate only needs to name one clinical supervisor within their application it is more than likely that they will work with more than one supervisor during their training.

Biomedical Scientists are expected to report within their area of training and experience and to work as part of an integrated reporting team, who will provide the wider general histopathology expertise. 

The development of the Histopathology Reporting programme allows more opportunity for Biomedical Scientists to develop and progress in their career should they wish to.

The Histopathology Reporting project is only one of the pieces of work that the College is involved in to address the workforce shortage in histopathology. The College has recently been successful in securing some funding for additional Histopathology StR training posts in England, for example, as evidenced in the latest recruitment statistics for 2022. The Pathology Portal is being developed to support training and ensure equal access to learning across all areas of the histopathology curriculum both doctors and scientists.

The College has updated and published guidance on Independent Reporting for Cellular Pathology trainees alongside the new Histopathology curriculum for 2021 which addresses this point.

Breaking new ground in histopathology: report from the pilot of BMS histopathology reporting, Dr Rachael Liebmann, The Bulletin, January 2015

Biomedical Scientists in Histopathological Reporting – joint statement between the RCPath and IBMS, May 2017

Yes, we are reviewing this in partnership with the IBMS.

This is highly unlikely because of the way in which the programme has been established. 

Histopathology Reporting is overseen by the Conjoint Board which is made up of RCPath and IBMS members, with reporting via the Cellular Pathology SAC and then Council for the College.

The curriculum mirrors relevant aspects of the histopathology curriculum but only in the areas of practice relevant to the subspecialty areas and with appropriate entry requirements for Biomedical Scientists. There are many other examples of similar programmes across medicine – for example Physician Associates and Nurse Practitioners. It should also be noted that the College has published a range of HSST curricula for Clinical Scientists, which requires them to pass the full FRCPath examination in the relevant specialty.

The CCT for BMSs provides evidence that the histopathology reporting training programme has been completed. Clearly it is not the same as the CCT awarded by the GMC and does not lead to entry to the GMC’s Specialist Register but we will be reviewing this in partnership with the IBMS.

The Conjoint Board minutes are published on the College website and these FAQs, derived from members, are also being openly shared.

The RCPath and IBMS have other Conjoint Boards in place, for example those in cervical cytology and non-gynaecological cytology. The Chair of the Histopathology Conjoint Board sits on the Cellular Pathology SAC and those minutes are received by Council. The College plans to address concerns by holding an event for RCPath members this year but there is also support for histopathology reporting by RCPath members. The views of all members have to be listened to.

The Conjoint Board is responsible for the Terms of Reference which were also agreed by the Histopathology SAC. These are also available on the College website.

No. Changes would have to be communicated to the Cellular Pathology SAC and College Council.

Yes, the College is part of the Conjoint Board and has equal representation. We share other Conjoint Boards with the Institute of Biomedical Scientists and remain supportive of the work they do.

Many of the original members of the Conjoint Board have left and been replaced. The College recently advertised for a new member of the Board to represent it. This was openly advertised via the College website.