Idaho WWAMI student explores pathology through prestigious fellowship

Pathologists are medical detectives. They’re puzzle solvers, piecing together signs and symptoms until they figure out a diagnosis.

From unknown brain masses to bone marrow biopsies, pathologists have their eyes on everything.

"Some people have described pathology as the doctor’s doctor,” said George Hodges, clinical associate professor at Idaho WWAMI. “People come to us all the time asking, ‘What is it? What should I do now? What does this mean?’”

For one second-year Idaho WWAMI student, Reagan Badger, an interest in specializing in pathology has earned her a place in a highly competitive pathology fellowship where she will spend the year acting as a first-year pathology resident, working within the various hospitals covered by UW pathology.

Pathology is the diagnostic evaluation of tissue and body fluid. It is a specialty used to answer questions about a patient’s symptoms, provide a diagnosis and subsequently, a course of action.

Hodges, a pathologist for 30 years before coming to teach at Idaho WWAMI, explained how pathology plays a unique role in providing medical care.

“Every case is like a little mystery that needs to be solved, and it’s really crucial that the diagnosis is right, because that’s the way the patient gets the right therapy,” Hodges said. “That was the most exciting part to me.”

While at Idaho WWAMI, students spend time during the Foundations phase — the first two years of medical school — studying pathology in the classroom, with the option to do an elective pathology rotation once they start their clinical rotations during the last two years of medical school.

“There is also a pathology fellowship that students can do either between their second and third year or third and fourth,” Hodges said. “It’s offered through the University of Washington. Students spend a whole year as a pathology resident. They only choose a couple of students every year. Several of our students have been chosen for this in the past.”

For Badger, receiving the fellowship was a step toward the career she had been pursuing since high school.

“I get to take on the role of a pathology resident and gain exposure to a variety of different fields,” Badger said. “This includes reviewing cases, attending teachings and research conferences and delivering presentations. I also work closely with residents and attending physicians within the program.”

Badger’s first three months of the fellowship were spent working in the lab as a clinical pathologist. The remaining nine months, she’ll spend in anatomic pathology assisting in tissue diagnosis.

“I always preferred anatomic pathology,” Hodges said. “Clinical pathology is overseeing the operation of the lab — it’s a lot of administrative stuff. Anatomic pathology is what most pathologists prefer to do. That’s where you do actual tissue diagnosis.”

Most recently, Badger did a rotation in coagulation — blood clotting.

“I really enjoyed interpreting red cell cases and learning about other pathologies,” she said. “I’ve been able to apply a lot of my knowledge from my first two years of medical school in a way that really enhances my understanding of these topics.”

Despite being an integral part of the Foundations curriculum, clinical rotations in pathology are not required by most medical schools, something Hodges said he wished would be updated due to the general misunderstanding of what a pathologist does.

“Most people view the pathology lab as a black box,” Hodges said. “You take a specimen, you send it into this black box, and it spits out an answer, but they have no idea what goes on in the background. All the instruments must be calibrated daily. Quality control has to be done every day. Not every instrument can give you an immediate response. Some lab tests take a couple of days to get done because the instruments are very specialized.”

Pathology is a team sport, and developing an understanding of what goes on in the lab is crucial for strengthening the working relationship between pathologists and others involved in patient care.

Badger agreed that having a foundation in pathology is important and can lay a foundation for other specialties.

“I know the skills and knowledge I take away from this fellowship will make me a better future physician,” she said. “I think having a strong foundation in pathology is important to all clinical practice. I see this experience sparking an interest in academic medicine and helping to guide my course of future specialty.”