SOCIETY FOR CARDIOVASCULAR PATHOLOGY FORUM ON CARDIOVASCULAR

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SOCIETY FOR CARDIOVASCULAR PATHOLOGYFORUM ON
CARDIOVASCULAR PATHOLOGY TRAININGVancouver, BC,
CanadaMarch 6, 2004Clinical, teaching and
research demands the CV pathologist expertise
Frederick J. Schoen, MD, PhD Department of
Pathology Brigham and Womens Hospital Harvard
Medical School e-mail fschoen_at_partners.org
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Cardiac/cardiovascular (C/CV) pathologists have a
varied mix of activities

• Diagnostic patient care activities (surgical
  pathology, autopsy) emphasizing C/CV disease
• Other clinical activities
• Forensic pathology
• Research pertinent to C/CV disease (basic,
  translational or clinical)
• Teaching C/CV pathology (to medical students,
  residents, clinician colleagues, others)
• Institutional administrative/leadership
  activities
• Professional/scholarship/regulatory/standards
  activities (local, national, and international)
• Corporate/medicolegal consultation activities
  pertinent to C/CV disease

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C/CVP clinical diagnostic roles are varied

• Surgical C/CVP
• Vessels
• Valves
• Endomyocardial biopsies
• Hearts
• Grafts, prosthetic devices
• Tumors
• Logical combined practices (e.g., pulmonary)
• Autopsy
• General
• C/CVP consultant
• Congenital heart disease
• External clinical consultation practice
• Forensic pathology
• Perinatal/hearts

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Research in C/CVP is opportunity rich

• Clinico-pathologic, translational, and basic
• Primary vs collaborative
• Immense collaborative opportunities (clinicians,
  laboratory investigators), especially in animal
  models for human disease
• Key access to human material (pathologist is
  steward)
• Important role in corporate research (drugs,
  devices)
• Diverse funding mechanisms

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C/CVPs play a key role in education/training at
all levels

• C/CVP in general and systemic pathology
• C/CVP in pathology GME (core curriculum)
• Conferences for clinicians
• Educational leadership/administration
• Fellowships in C/CVP
• CME
• Research training grants
• Other disciplines (clinical, science/engineering)
  biomedical engineering, cardiovascular biology)
• Diverse funding needs to be made available for
  education/training (institutional, federal,
  private, corporate)

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CV/CVPs arrive via diverse routes

• Pathologist who trains with the goal of C/CVP
  career
• Surgical/transplant pathologist who assumes C/CVP
  role owing to institutional needs
• Other pathologist assigned C/CVP owing to
  departmental/institutional need
• Cardiologist/surgeon/pediatrician who assumes
  role of C/CVP
• Physician-scientist seeking pathology
  sub-specialty integrated with research area

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Challenges derive largely from atypical
characteristics of C/CVP and C/CVPs

• income challenged
• relatively flexible clinical demands
• eclectic careers
• rare outside the academic environment (no private
  practice)
• must manage tension between dilution and
  enrichment
• frequently arrive via non-conventional pathways
• frequently have other training, multidisciplinary
  (clinical training, research, engineering, etc.)
• declining clinico-pathologic investigation in
  C/CVP
• The need for C/CVP will continue
  indefinitely however just as the growth of
  heart transplantation in 1980s crystallized
  C/CVP as a specialty and raised its profile, the
  loss in luster/activity level in heart
  transplantation may diminish the perceived added
  value C/CVP.

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The advocacy role of the SCVP will be critical to
address ongoing issues for C/CVP

• Define role of/secure funding for academic C/CVPs
  (demonstrate institutional value)
• Recognize/reward diverse career development
  pathways
• Recruit into the subspecialty
• Define training for the practice of C/CVP
  (?core/?clinical, other tailored to
  needs/interests/career paths)
• Define core curriculum for C/CVP in AP/CP
  training
• Define roles for C/CVP external to conventional
  academic practice
• Generate unconventional sources of training
  support