Pathology: Specialty Training Interview Questions Australia

Why pathology, and which discipline (anatomical, chemical, haematology, microbiology, immunology, genetics, forensic, general) and why?

Why pathology in terms of the work: the diagnosis at the microscope or in the data, the responsibility for the result the hospital depends on, the consulting role. Which discipline and what a day in it looks like. Evidence that you chose the laboratory: time in it, a project, a mentor.

What do you know about the RCPA training programme and its examinations?

The disciplines, the examinations and when they fall, the supervised training requirements. Two accurate sentences, then the honest acknowledgement of the study load and how you would manage it.

What makes you suited to laboratory medicine, and what will you miss about clinical work?

Qualities with evidence: attention to detail, scientific reasoning, comfort with the laboratory's pace, communication with clinicians. Then what you will miss, honestly: the patients, the immediacy, the ward team, and how your discipline keeps some of it.

What experience have you had in a laboratory or with pathology beyond ordering tests?

Specific: the time in the laboratory, what you saw, what you did, a project if you have one. If your experience is thin, say so and say what you have done to find out what the work involves.

How do you see pathology changing with genomics and automation?

Genomics transforming genetic pathology and reaching every discipline, automation changing the analytical side, the pathologist's role moving toward interpretation, integration, governance and consultation. Say what you have seen and what you would want to learn.

A clinician phones about an unexpected critical result. How do you handle the call and what do you document?

Confirm the result is real, phone the treating clinician directly, state the result plainly with a recommendation where the laboratory has one, read back, document who, when and what was said, and escalate to the pathologist. Say what you would do if the clinician could not be reached.

A surgeon wants a frozen section result faster than is safe. What do you say?

Explain why the time is needed for a safe result, say what you can do to speed what can be sped, involve the pathologist if the surgeon insists, and do not issue a result you are not confident in. Keep the relationship; the surgeon will be back next week.

Tell us about a time you explained a complex result to a clinician who disagreed with it.

A real example: the result, the disagreement, how you explained the science in terms of the patient, whether the pathologist was involved, and the outcome. If you were wrong, say so.

You notice that a colleague's reporting error has gone out and may have changed a patient's treatment. What do you do?

The patient first: find out whether treatment has been affected and tell the treating clinician now. Then the pathologist and the colleague, without blame. An amended report, open disclosure through the treating team, the incident report and the review of the system. Say what you would do if the colleague asked you not to raise it.

A clinician asks you to add a test to a sample without the patient's consent. What do you do?

Most added tests are routine and covered by the original consent; some, such as genetic tests and HIV, are not. Ask what the test is, know the difference, decline the ones that need specific consent until it is obtained, and explain why to the clinician.

A specimen has been mislabelled and two patients may be affected. What do you do?

Stop and issue neither result. Identify what is known, follow the laboratory's procedure, which usually means rejection and recollection rather than guessing, tell the clinicians of both patients, and report the incident. Never work out which sample was whose from the results.

A full blood count shows a white cell count of 150 with blasts. What do you do, and who do you call?

Acute leukaemia until proven otherwise: the film reviewed, the pathologist told now, the treating clinician phoned directly with the result and the urgency, the haematology team involved, and the documentation of the call. Say that the patient needs to be in hospital tonight.

A blood culture grows a gram negative organism at 2 am. What happens next?

The gram stain result phoned to the treating clinician now, with the organism's likely identity and the antibiotic implications, the read back, the documentation, and the laboratory's after hours process followed regardless of the hour. The identification and sensitivities to follow.

A potassium of 7.5 comes through on a sample. How do you decide whether it is real, and what do you do?

Consider whether it is real: haemolysis, the sample type, the time to separation, the patient's clinical picture. A repeat if there is doubt, but without delaying the call if the clinical picture fits. Then the direct call with the result and the recommendation, the read back, the documentation.

A biopsy shows an unexpected malignancy in a young patient. How is that result handled?

The pathologist reviews it, the report is clear about the diagnosis and the urgency, the clinician is contacted directly so the patient is not left waiting, and the result is flagged. The patient is told by the treating clinician, not the laboratory; the laboratory's job is to make sure the clinician knows fast.

What is laboratory accreditation, and why does it matter?

The standards, the inspection, the quality systems, the external quality assurance, and why it underpins every result the laboratory issues. Say what you have seen of it and what a trainee's part in it is.

What are the main pressures on public pathology services at the moment?

Funding, workforce, the consolidation of laboratories, the cost of genomics, turnaround pressure, and the gap for rural hospitals. Say what a trainee can do about one.