Perinatal pathology – hope for the future? The Trainees perspective

Perinatal pathology – hope for the future? The Trainees perspective

Authors: Daniel Nuzum (1), Brendan Fitzgerald (3), Keelin O’Donoghue (1,4), Margaret Jane Evans (2)

(1) Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland; (2) Department of Pathology, Edinburgh Royal Infirmary, Edinburgh, Scotland; (3) Department of Pathology, Cork University Hospital, Wilton, Cork, Ireland; (4) Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.

Introduction:
Post-mortem and placental examination provides valuable information in stillbirths and neonatal deaths but the number of perinatal pathologists is falling. Objectives: This study looks at barriers to recruitment.

Methods:
Voluntary, anonymised online questionnaire- based study of trainee pathologists (UK and Ireland)

Results:
Twenty nine trainees responded. 8 underestimated the stillbirth rate (1 in 1000); 4 overestimated it (1 at 1 in 50; 3 at 1 in 100). GI pathology was ranked the most important specialty by 14 (48%) and perinatal pathology most important by 2 (80% of cases and six in <20% of cases. 9 (31%) had encountered negative comments about the specialty from other trainees and/or relatives. 27(93%) felt that bereavement training should be offered to those entering the specialty. 19 had been involved in examining placentas, 12 felt clinicians were disinterested in findings. The main barriers were, small specialty (9), autopsy focus (8) and number of placentas (3). 16 (55%) had considered the specialty but commented that paediatric and perinatal should be split due to the distressing nature and lack of interest in autopsy.

Discussion:
Nearly half of trainees surveyed misquoted the stillbirth rate and the impact of post-mortem and placental examination on diagnosis. The main barriers to entering the specialty included “distressing” autopsy work, onerous placental work and few training centres. Negative comments were not a deterrent. The selection of GI as the most important specialty by the majority may reflect early exposure to the discipline. These issues could be resolved by early exposure to perinatal pathology and the development of novel, tailored training programmes with ““top up” modules in specialist centres.

Ethics Statement:
Ethical approval for this study was granted by the Clinical Research Ethics Committee of the Cork Teaching Hospitals (Ref No: ECM4(a) 07/03/18)

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