Abstract
To the Editor,
The Covid pandemic with lockdowns and social limitations has changed society. One consequence is more remote work for the laptop class (or laptop and microscope class for veterinary pathology). This has impacted our work for better and worse.
Pathology residency programs are primarily in diagnostics. Pathologists supporting drug development accumulate on-the-job experience, refining their skill and experience based on projects assigned. Historically, this was in the context of groups of pathologists (2 or 3 to more than a dozen) co-located at a corporate laboratory-office. Extensive sharing of findings and historical context provided guidance for newly certified pathologists, critical to assuring the completeness and accuracy of the pathology report. 1
The Covid pandemic resulted in many, if not most, pathologists working from home. This has positive aspects such as avoiding commuting, more flexible hours, and quiet uninterrupted work periods. But what is the consequence for pathologists who started their toxicologic pathology career working remotely due to the pandemic? Do these individuals get the mentoring necessary?
The impression based on pathology peer reviews done by myself and of some colleagues is that many early career pathologists are not getting the pre-pandemic benefit of working in groups. This makes the pathology peer review process even more important than previously.
Pathology peer review is a common practice that is well developed and widely recognized by regulatory agencies and industry as a valuable part of toxicologic pathology in today’s world.2 -4 Pathology peer review is a sponsor option. Most large pharma companies peer review almost everything. Note also that large pharma companies have the advantage of a list of preferred pathologists at their contract research organizations (CROs) which include only those more experienced. On the other side of the coin are the numerous small, boutique, venture capital–funded companies running nonclinical studies for their own drugs and therapies. These companies generally do not recognize the value of peer review and forgo peer review because it extends timelines and increases cost. This problem is compounded because the experienced pathologists at CROs are often scheduled up by larger companies and not available for these smaller companies. Without the consultation of a knowledgeable toxicologist, the small companies have a peer review done only when they question the primary pathology evaluation. Often, these are when a spontaneous finding has been misidentified as a test article–related finding. Therefore, some of the false positives are corrected by these unplanned, last minute (and often directed) peer reviews. By the same logic, false negatives are potentially being missed.
By the nature of our profession, we regularly see things that are new to us and possibly never seen before by anyone—one reason our profession is so interesting. For all of us, peer review is helpful for refining diagnoses, and even an experienced pathologist could misidentify findings related to test article. Consensus feels good.
The profession should consider the proposition that we need to re-evaluate and re-assess our practices of remote work, especially in regard to the effect for early career individuals. More senior and more experienced pathologists need to be available to supply the critical daily mentoring. Discussion of slide scans and photos is a start, but it isn’t adequate nor the complete solution. Individuals working remotely often do not know what they do not know. Do you remember Friday afternoon tox path slide rounds at the multiheaded microscope? That was richly fertile ground for mentoring, camaraderie, and career building for all involved.
Do you recognize our changed mentoring environment as a potential problem? Let’s all give this some thought to find remedies, encourage mentoring, and encourage the sponsors not doing peer review to build this into their drug development programs.
