Histopathology

The NHS offers an extensive training scheme and career development for histopathologists, and the quality and depth of this programme is recognised as a gold standard across the medical community.  The training provided to UK histopathology trainees is regularly reviewed and updated, in keeping with advances and progression in the landscape of pathology around the world and across the profession. This makes the training programme attractive to UK graduates, as well as overseas histopathologists seeking the best training programmes for their field.  In this article, we will explore the training pathway for histopathologists in the UK, covering the following topics:  What is the NHS Training Pathway? How do you enter the training pathway? What does the specialty training programme look like for histopathology? What happens after completing the histopathology training programme? Can I enter specialty training in the UK as an IMG? The NHS Training Pathway  The NHS training pathway is the name given to the complete programme undertaken by UK trainees, from medical school to the completion of specialist training within I.e. within histopathology.  It is important for IMGs to understand this as it helps to provide an understanding of at what stage they can most likely enter the system if they are interested in training in the UK.  Entering the NHS Training Pathway  After graduating from medical school, doctors with receive provisional registration from the GMC which allows them to enter the Foundation programme (a two-year work-based training programme).  Upon completion of the first year (FY1), doctors will gain full registration with the GMC and will be able to apply for further study and training in a specialised area I.e. histopathology – this is known as Specialty Training (ST).  Specialty Training in Histopathology  The Specialty Training programme in Histopathology is 5 years long, and whilst doctors may pass through training quicker depending on how quickly they achieve their competencies, this is rarely the case and histopathologist will usually take the indicated time, or slightly longer to complete the Specialty Training programme.  Successful applicants entering into year one of specialty training (ST1), will follow the Royal College of Pathologist’s 2021 Histopathology Curriculum, which sets the expected syllabus as well as required assessments and workload case numbers.   Histopathology training as a run-through programme  Unlike some specialisms where you complete a period of core training before entering into specialty training (requiring two applications), histopathology specialty training works as a run-through programme. You only have to apply once, at the beginning of the programme, as you are recruited for the full duration of Specialty Training.  Foundation Training (FY1 – FY2)  The foundation programme usually involves six different rotations or placements in medical or surgical specialties. These rotations enable trainees to practise and gain competence in basic clinical skills.  Specialty Training (ST1 – ST5+)  ST1) Year one trainees enter the training programme. In this first stage, trainees will initially develop knowledge of laboratory work, with basic training in all areas of cellular pathology.  Training starts with a 1-2 week induction from the training school. This includes some time in the lab seeing how specimens are prepared and processed. Trainees are taught how to use a microscope, how to approach simple cases under the microscope and the principles of macroscopic assessment and sampling (AKA ‘cut up’). Many training schools do a separate autopsy induction.  When not at block teaching weeks, trainees are rotating through the various specialities in histopathology.  ST2 – ST3 This part of training takes place from year 2 to year 3, with the focus on achieving the FRCPath Part 1 Exam. This will normally be taken after 18 – 24 months of training.  Trainees will consolidate and develop their knowledge base from ST1. Year two trainees are given more independence and are expected to be able to cut up most specimens by the end of this stage.   In many deaneries, this is the time when trainees complete rotations in sub specialities including paediatric pathology, neuropathology and oral pathology. Trainees may rotate to placements in local district general hospitals to gain valuable experience in managing a general histopathology workload.  Autopsy and cervical cytology training continue as mandatory elements of ST2-ST3. Some trainees choose not to continue these specialities when they have completed this stage.  The FRCPath Part 1 exam aims to determine whether you have successfully acquired a core body of knowledge that will underpin your ability to practise in Histopathology.  For more information of the first exam in the Royal College of Pathologists examination suite, take a look at our IMG Resources library here.  Please note, trainees must pass the FRCPath Part 1 examination at the end of ST3 in order to progress to ST4.  Selection  Here, trainees will either choose to continue with general histopathology or peruse subspecialisation in neuropathology, paediatric/perinatal pathology, cytopathology or forensic pathology. ST3 – ST4 This training takes place from years 3 – 4, where trainees will either continue with general histopathology or peruse subspecialisation in neuropathology, paediatric/perinatal pathology, cytopathology or forensic pathology. Trainees are expected to be competent in the macroscopic and microscopic assessment of all specimens, and will also receive training in leadership, management and teaching in preparation for their future roles as consultants.  The focus during this stage is also on achieving the FRCPath Part 2 Exam, thereby obtaining the status of Fellow of the Royal College of Pathologists.  This final exam is designed to test your practical skills and understanding, and show that you can apply your expertise appropriately and safely.  Trainees who wish to continue in general histopathology may opt to sit further exams in cervical cytopathology and autopsy practice if they wish to continue these as a consultant.  To learn more about the final exam in the in FRCPath examination suite, read our detailed blog here.  Please note, trainees must pass the FRCPath Part 2 examination at the end of ST4 in order to progress to ST5.  ST5+ This is the final stage of training before CCT during which histopathology trainees may wish to peruse special interests in particular subspecialties, such as gastrointestinal, skin or gynaecological pathology. Having passed the FRCPath Part 2 exam, trainees will continue to take on responsibility to enable the transition to independent practice required of those with CCT, i.e. signing out reports without consultant review.  Completion of the Histopathology Specialty Training Programme  Upon completion of the training programme, the choice is made as to whether the trainee will be awarded a Certificate of Completion of Training (CCT) in Histopathology. This will be based on criteria set out in the curriculum by the Royal College. You can find the 2021 curriculum here.  At this point, the histopathologists are entered onto the specialist register and can now take permanent consultant posts in the NHS.  Specialist Registration for overseas doctors  Doctors who completed part or all of their histopathology training outside of the UK are eligible for specialist registration through the CESR or CESR-CP pathways. To learn more about specialist registration for overseas doctors, read our blog here.  Joining the Histopathology Specialty Training Programme as an IMG  It is possible for overseas doctors to join the Specialty Training programme in Histopathology in the UK, however it is very competitive.   IMGs interested in UK specialty training must have:  Full GMC registration   Completion of a minimum 12-month (FY1 equivalent) internship  English language test  PLAB  AND  12 months post-internship experience by the time you begin ST1  Although UK trainees are not given priority for specialty training places, it can be very difficult to join the Specialty Training programme without NHS experience.  So here you have it, the NHS Specialty Training pathway for trainees in a nutshell. This training scheme is the core of training for histopathologists in the UK, and for IMGs looking to join the training programme, understanding of the pathway allows you to better align your overseas training with the relevant stage you would enter into Specialty Training in the UK.  If you have any further questions about your route to the UK as an overseas histopathologist, FRCPath, or any other aspect of GMC Registration, the NHS or the UK, please get in touch with us here.   We'd also like to invite you to join the IMG Histopathologists online community - as well as support on Royal College exams, our Facebook group of international pathologists and dedicated pathology recruiters offers guidance on other aspects of working in the UK, including finding NHS posts and CESR.  Follow us on social media through the links below for regular news and updates on the Royal Colleges, relocating to the UK and working in the NHS:             

In response to the high number of inquiries we've had from overseas pathologists about the arrangements for the Autumn sitting of the FRCPath Histopathology Part 2 exam, we've been in contact with the Royal College of Pathologists and have summarised these updates under the headings below. When will the FRCPath Histopathology Part 2 exam be held? The publicised dates for the exam are Tuesday 11 and Wednesday 12 October 2022, although these are subject to change due to the ongoing COVID-19 pandemic. The withdrawal deadline for the exams is Friday 15 July 2022. Can I sit the FRCPath Histopathology Part 2 exam in Autumn 2022? The RCPath guidance which asks candidates to wait to sit the Part 2 exam the year after passing the Part 1 exam was in place to avoid overwhelming the limited capacity of the exam centres. Those who were successful in the Spring 2021 Part 1 exam are able to sit the Part 2 exam in Spring 2022. If the College needs to prioritise bookings, it will be done in the same way as previously. Therefore, if there is a requirement for candidates who have passed in Spring 2022 to wait until Spring 2023 to apply, a notice will be put on the News section of the examinations page around the end of May/ beginning of June. It is therefore important to check regularly for updates to the examinations page, which you can do here. Where can I sit the FRCPath Histopathology Part 2 exam in Autumn 2022? Details on the Autumn 2022 sitting of FRCPath Part 2 have yet to be finalised, however, unlike Spring 2022, it may be possible to arrange to sit the exam in Irbid (Jordan), Dubai (UAE) or Cairo (Egypt) if there are sufficient applicants. The availability of FRCPath Part 2 examination centres outside the UK will be indicated on the Royal College website (when the application window opens for Autumn 2022 at the end of May) and candidates should contact the Examinations Department to express their interest in taking the exam in the available centre when they make their application. We therefore advise that you keep an eye on the RCPath application page here. Will the College have any microscopes available for me to use for the exam? The College's overall policy is that the College and centres have no obligation to provide microscopes. Candidates can bring their own as this is equipment they are familiar with, or can hire a microscope. Some overseas centres may be more able to provide microscopes and if that is the case it would be stated on the letter sent to candidates with their centre confirmation.  If you would like to borrow a microscope for your FRCPath Histopathology Part 2 exam, we advise that you check well in advance what the options are for your chosen centre, or are available to you online.  If you have any further questions about the FRCPath exams, your route to the UK as an overseas histopathologist, or any other aspect of GMC Registration, the NHS or relocating to the UK, please get in touch with us here.   We'd also like to invite you to join the IMG Histopathologists online community - as well as support on Royal College exams, our Facebook group of international pathologists and dedicated pathology recruiters offers guidance on other aspects of working in the UK, including finding NHS posts and CESR.  Follow us on social media through the links below for regular news and updates on the Royal Colleges, relocating to the UK and working in the NHS:             

Are you an overseas histopathologist looking to sit the FRCPath exams?  Today we’re bringing you a guide on how to prepare for the FRCPath Histopathology Part 1 exam from Dr Maria, clinical fellow in cellular pathology in London. Maria passed the FRCPath Part 1 exam in March 2021 and is sharing her top tips for FRCPath aspirants, including study planning, revision materials and what you should know about the Part 1 exam.  1. Create a plan and schedule for your study (this is most important!)  I started studying around 3 months before the exam, spending 2-3 hours per day on weekdays and around 5-7 hours on study at the weekend.  REMINDER: This all depends on how much you know already. You cannot focus constantly for hours, so you should schedule your studying time around the way that you know you work best.  Leading up to the exam  Try to keep at least 2 weeks free prior to the exam to re-revise problematic topics and genetics.  The day before exam  Be kind to yourself. Have a good meal, try to relax if you can and avoid stressing too much. Go to bed early and have a good, long sleep.  2. Revision materials  I had been revising using my old notes, where I studied from these books (the best for trainees in my opinion):  Foundation in Diagnostic Pathology series Dermatopathology  Pulmonary Pathology  Hematopathology  Head and Neck Pathology  Gynecologic Pathology  Bone and Soft Tissue Pathology  Cell and Tissue Based Molecular Pathology  Pulmonary Pathology  Fine Needle Aspiration Cytology  Genitourinary Pathology  Breast Pathology  Neuropathology  Gastrointestinal and Liver Pathology  Diagnostic Pathology series Diagnostic Pathology: Head and Neck  Diagnostic Pathology: Genitourinary  Diagnostic Pathology: Spleen  Diagnostic Pathology: Thoracic  Diagnostic Pathology: Neuropathology  Diagnostic Pathology: Hepatobiliary and Pancreas  Diagnostic Pathology: Nonneoplastic Dermatopathology  Diagnostic Pathology: Neoplastic Dermatopathology  Diagnostic Pathology: Bone  Diagnostic Pathology: Breast  Diagnostic Pathology: Familial Cancer Syndromes  Diagnostic Pathology: Molecular Oncology  Diagnostic Pathology: Infectious Diseases  Diagnostic Pathology: Gastrointestinal  Diagnostic Pathology: Kidney Diseases  Diagnostic Pathology: Placenta  Diagnostic Pathology: Gynaecological  Diagnostic Pathology: Transplant Pathology  Diagnostic Pathology: Cardiovascular  Diagnostic Pathology: Intraoperative Consultation  Diagnostic Pathology: Cytopathology  Diagnostic Pathology: Paediatric Neoplasms  Diagnostic Pathology: Endocrine  Diagnostic Pathology: Normal Histology  Diagnostic Pathology: Lymph Nodes and Extra-nodal Lymphomas  Diagnostic Pathology: Blood and Bone Marrow  Diagnostic Pathology: Vascular  Diagnostic Pathology: Hospital Autopsy  There are so many books, and it would be too expensive to purchase them all, so stick to what you've got in your department or can borrow from friends or colleagues.  The Pathology Outlines website is also excellent for quick review and genetics! There are also MCQs.  Some trainees study from the Robbins Pathology books, however, in my opinion, this book alone is not enough for the Part 1 exam.  For the MCQs, I used the following resources:  Practical Applications in Histopathology, Cytopathology and Autopsy: an MCQ/ EMQ Resource – Limci Gupta, Jayson Wang, Val Thomas  Anatomic Pathology Board Review – Jay H. Lefkowitch  Robbins Review of Pathology - Edward Klatt, Vinay Kumar  Sternberg's Diagnostic Surgical Pathology Review – Pier Luigi Di Patre, Darryl Carter  Various past papers I found within my network  If you have access to old presentations from FRCPath Part 1 courses, I’d suggest having a look at them. It’s a good idea to use them to review and revise a topic, followed by some MCQs on that topic.  TOPIC  START DATE  DURATION  Breast  27 October 2020  6 days  GIT  2 November  8 days  Liver, GB, Pancreas  10 November  8 days  Skin  18 November  6 days  Endocrine System  24 November  7 days  CNS  1 December  7 days  Renal & Urinary  8 December  9 days  Bone  17 December  5 days  Soft Tissue  22 December  9 days  CVS  31 December   5 days  Thoracic Pathology (Lung & Mediastinum)  5 January 2021  7 days  Lymph Node  12 January  7 days  MGT  19 January  7 days  FGT & Placenta  26 January  8 days  Oral & Nasal  3 February  7 days  Autopsy & Forensic  10 February  7 days  General  17 February  7 days  Cytopathology  24 February  5 days  Clinical Governance  1 March  5 days  Syndromes & Paediatric  6 March  5 days  General Revision  11 March onwards  -  This is a guide to the revision schedule I used for my FRCPath preparation. I actually started studying in December, so I had less time to fit this all in, but I was able to revise faster to cover everything.  3. FRCPath Part 1 Exam  The questions in the FRCPath Part 1 exam are usually quite straightforward, so you either know the answer or you don't, nothing misleading or tricky.  Some key topics you’ll need to know for the exam:  Genetics and the mutation of tumours (and yes...you'll need to learn each tumour that has any typical mutation and its name)  Immunohistochemistry of lesions  Microscopic pictures (all the micro images I had in the test depicted typical morphology)  Genetic syndromes, the mutations behind them and what lesions are most common  Datasets - they are quite wordy, so focus only on pTN, and the stage of each organ system  Audit  Parts of a microscope  There were some questions from general pathology (necrosis, inflammation, etc.), but I’d say most of the questions were from GI, breast, gynae, skin, soft tissue and kidney.  However, you'll have at least a few questions from each of the other organ systems, so it's better to study everything rather than focus on the most common ones only.  #IMG Tips  Prepare early – try to start your preparation early to give yourself enough time to cover all the relevant sections on the Royal College curriculum.  Find the right materials to support your study – it's good to use a combination of resources for your study to reinforce existing knowledge and benchmark your progress. Try to find the right materials for you as early as possible to hit the ground running with your revision.  Familiarise yourself with the Royal College curriculum – we cannot stress this enough! All countries have different training programmes, so being well versed in what the RCPath will be looking for is key.  Join the IMG Histopathologists community – as well as support on Royal College exams, our online community of international pathologists and dedicated pathology recruiters offers guidance on other aspects of working in the UK, including finding NHS posts and CESR.  Getting started  Attaining FRCPath Histopathology is a great first step for histopathologists wanting to find senior roles in the NHS. It can be difficult for overseas trainees to prepare for the first exam in the Royal College examination suite, but this quick guide from a successful FRCPath pathologist is a great start for pathologists pursuing the postgraduate route to GMC registration and finding work in the UK. For more information on the FRCPath exams, take a look at our IMG Resources library. If you have any further questions about FRCPath, your route to the UK as an overseas histopathologist, or any other aspect of GMC Registration, please get in touch with us here.   Follow us on social media through the links below for regular news and updates on the Royal Colleges, relocating to the UK and working in the NHS:             

IMGs from any country in the world can apply for Specialist Registration, provided certain eligibility criteria are met, though there are different routes available based on a doctor’s qualifications and training.  Here we explore specialist registration in histopathology for overseas consultant pathologists and specialists more closely. We’ll cover the Certificate of Eligibility for Specialist Registration (CESR) specifically, including the application, costs, and eligibility criteria, along with some other topics, summarised in the headings below:  What is Specialist Registration? What route to Specialist Registration is best for me as an overseas pathologist? Do I have to complete CESR before I can work in the UK? Do I need FRCPath for Specialist Registration? What is the CESR equivalence process? What evidence do I need to submit for a CESR in histopathology? How much does CESR cost? How long is the CESR application process? #IMG Tips How do I get started? Skip ahead to the relevant section if you know what you’re looking for.  Specialist Registration  Specialist registration in any specialty means that you can be appointed to a substantive (permanent) consultant position in the NHS. All physicians who wish to take permanent consultant roles in the UK must show evidence of skills, knowledge, and experience in order to gain Specialist Registration.   Specialist Registration is additional to full registration with the GMC and is therefore not required to practice as a histopathologist in the UK.  Routes to Specialist Registration  There are three types of certificates issued by the GMC for specialist registration across all specialties, and the type of certificate you receive depends on which training route you followed.  For pathologists who have completed their full training outside a GMC-approved training programme, CESR is the route they will usually take towards attaining specialist registration. This route does not require further training, but rather the submission of an application.   Doctors who have trained outside the UK or Switzerland, but within an EEA country, will be awarded CCT (Certificate of Completion of Training) after a successful specialist registration application. Specialist Certifications from across the EU are deemed as equivalent by the GMC, and therefore a straightforward application can be made.   Pathology Positions in the NHS without CESR  It is important to note that you attain more senior histopathology roles in the NHS, such as a specialty doctor (SAS), specialist grade or a locum consultant without being on the Specialist Register.  Similarly, overseas doctors do not require CESR before moving to the UK to work in the NHS.  In these NHS roles, you will have better pay and responsibilities that are more appropriate to your level of experience compared to a trainee. While working in these positions, you can collect evidence of your competences, particularly those specific to the UK histopathology curriculum.  These positions also facilitate a faster route to the UK than the CESR route, which can take a substantial amount of time.  FRCPath for Specialist Registration  Whilst it is always beneficial pathologists to complete FRCPath, overseas doctors looking to join the Specialist Register do not necessarily need to have completed the Royal College postgraduate exams.  The standard test of knowledge in the CCT curriculum are the FRCPath exams, so passing these exams confirms the attainment of the competencies of the Histopathology Curriculum.  FRCPath is only a requirement for doctors looking to attain Specialist Registration via the CCT route.  However, if CESR applicants have not successfully completed these exams, they must provide alternative evidence that demonstrates equivalent knowledge to histopathologists who have passed the FRCPath exams.  Even if the competencies covered by the exams require something that someone in your position would not routinely undertake (in your sub-specialty for example), you must still provide evidence of it – as the evaluators will not make assumptions outside the evidence presented.  CESR Equivalence Process  Equivalence describes the process of assessing an overseas applicant’s training and experience against the current histopathology training programme requirements, in order to be awarded CESR.  The equivalence process involves submitting a written body of evidence to the GMC, consisting of:  training and/or competence  skills and knowledge  The Royal College of Pathologists will assess each application against the relevant Curriculum before providing a recommendation to the GMC, who will then make a decision.  Please note that Equivalence procedures are the responsibility of the GMC. Applications are made through their Certification Department and initial enquiries should be directed there.  Evidence Requirements for CESR in Histopathology  Skills & Experience: The evidence provided for a CESR application in histopathology must cover the knowledge, skills, and qualifications to demonstrate the required competencies in all areas of the Curriculum for Specialty Training in Histopathology. If evidence is missing from any area of the curriculum, the application may be unsuccessful.  Capabilities in Practice: The Royal College of Pathologists has divided the Training Curriculum into 11 different Capabilities in Practice (CiPs) – each comes along with its own descriptor and guidance on where such CiPs would be evidenced.  Applicants are required to gather evidence by area of competence and attach this under the relevant section of the online application.  Generic CiPs  Able to function effectively within healthcare and other organisational and management systems to deliver consistent high-quality patient care.  Able to work within ethical and legal frameworks across all aspects of clinical practice.  Communicates effectively and is able to share decisionmaking, while maintaining appropriate situational awareness, professional behaviour and professional judgement.  Maintains patient safety at the forefront of clinical working. Can utilise quality improvement activity realistically within the constraints of the role.  Able to contribute to and support research.  Behaves as an educator in the context of the role and promotes educational culture.  Able to self-appraise, learn and adapt.  Histopathology-specific CiPs  Able to demonstrate leadership and management within the laboratory setting for the benefit of patient care.  Able to use laboratory and other services effectively in the investigation, diagnosis, and management of patients, relatives, and the deceased.  Able to manage and contribute to a multidisciplinary team effectively.  Able to take, manage and interpret pathological specimens accurately and safely, mindful of risks to self and others.  Audit and Governance: You are required to submit evidence of your active leadership in audit, including evidence that you have completed at least one audit cycle. Currency of evidence: Your evaluators will be looking for evidence of current competency, generally defined as within the last five years. If you have completed training before this point, it is crucial that you provide evidence of maintaining competency across the whole area of the curriculum.   The GMC asks that only evidence that is strictly relevant is sent as it will help them to process the application quicker. The guidance on compiling your evidence will help you to decide what is relevant and what is not – you can find this on the GMC website here.  As a general guide, the GMC usually expects to see about 800-1000 pages of evidence, divided into four different domains, reflecting those of Good Medical Practice. The GMC recommends that you apportion the evidence provided as shown below:  Domain 1 - Knowledge, skills, and performance  Domain 2 – Safety and quality  Domain 3 – Communication, partnership, and teamwork  Domain 4 – Maintaining trust  Please note, you cannot compensate for evidence lacking in one area by providing more evidence in another area.  The full list of evidence required for each domain can be found on the GMC website here.  The Cost of CESR Applications  All histopathology applying for Specialist Registration must pay a fee. For CESR, this fee is £1,676. For CESR-CP and CCT, the cost is £439.  How long does it take to complete a CESR in Histopathology application?  The GMC estimate that it can take between six and eight months to receive a decision, from the date you submit your CESR application.  As there is a substantial amount of evidence to gather for a CESR application, the process of preparing all the necessary documentation and applying for CESR can take even longer than this, and a typical candidate will usually set out to complete this within 1 – 3 years.  It is worth noting that more senior histopathologists, such as consultants, are more likely to have achieved all the competences outlined in the curriculum.  The indicative period of training for a CCT in histopathology is five years, so it is highly unlikely that you would achieve the competencies required for a CCT in a shorter period of time. Therefore, CESR is not suitable for more junior pathologists.  #IMG Tips  Research/think about the types of evidence you will need and begin to gather your evidence well in advance of making your application.   Gather evidence prospectively – this is much easier than retrospectively trying to pull together the evidence under additional pressures.  Make sure that your evidence is of the highest possible quality and is current – you will be assessed against the most recent curriculum.   Ensure that the evidence you collect demonstrates your competence across the whole of the histopathology curriculum, not just your sub-specialty.     Remember to refer to the most up-to-date Histopathology Specialty Training Curriculum and Specialty Specific Guidance for the evidence requirements in your specialty.   Create a CESR ‘to-do list’ with sections under the 11 CiPs headings – organise your evidence directly into these sections to manage your progress.  Do not submit original documents – all your copies, other than qualifications you’re getting authenticated must be accompanied by a proformas signed by the person who is attesting to the validity and accuracy of your evidence (your verifier).  Ask an IMG Connect recruitment specialist about NHS histopathology posts with CESR support. These are not always advertised by the Trusts, but we can help you find a role which aligns well with your career goals in the NHS.  Join the IMG Histopathologists community – as well as support on Royal College exams, our online community of international pathologists and dedicated pathology recruiters offers guidance on other aspects of working in the UK, including finding NHS posts and CESR.  Getting started  Many pathology IMGs likely haven’t completed a UK-approved training programme, but you could be eligible for Specialist Registration with the GMC via the CESR route. Take a look at our guide to CESR Applications for Histopathology for more information on how to apply and what to expect.  If you have any further questions about Specialist Registration, your route to the UK, or would like guidance in finding NHS histopathology posts which offer CESR support, please get in touch with us here.   Follow us on social media through the links below for regular news and updates on the Royal Colleges, relocating to the UK and working in the NHS:              

The first exam in the FRCPath Histopathology series...  International histopathologists (or cellular or anatomical pathologists as commonly known) looking to secure a job in the NHS via the postgraduate qualification route will need to attain Fellowship of the Royal College of Pathologists. This can also be commonly referred to as FRCPath Histopathology.  The completion of Part 1 and Part 2 of the Royal College of Pathology qualification for Histopathology results in eligibility for GMC registration (with the addition of the English language component). The FRCPath qualification is recommended for overseas pathologists looking to securing senior jobs in the NHS.  The exams can be taken by IMGs from all over the world, provided certain eligibility criteria have been met. Here we’ll take a closer look into these and other important questions through the following topics:  An overview of FRCPath Histopathology What is FRCPath Part 1 and how is it structured? Changes to FRCPath Part 1 delivery Am I eligible to sit this exam? How much will the exam cost and how do I apply? What is the best way to prepare for the exam? #IMG Tips I’ve passed the FRCPath Part 1 exam, what’s next? Skip ahead to the relevant section if you know what you’re looking for.  An overview of FRCPath Histopathology  The FRCPath Histopathology exams are administered by the Royal College of Pathologists to test a doctor's knowledge and ability to apply this in the practice of histopathology within the scope of the Specialty Training Curriculum for Histopathology.  The exams are as follows:  FRCPath Part 1  FRCPath Part 2  To read more about the full FRCPath examination suite via our IMG resources, please click here.  Please note that only full FRCPath satisfies the requirements for GMC registration for overseas doctors taking the postgraduate route.   Alternative routes to GMC registration include PLAB and other licensing exams such as USMLE. You can find out more about alternative routes here.  For doctors who are interested in more senior roles in the NHS that are reflective of their current practice, we advise that FRCPath is the best route to take to GMC registration. Histopathology in the UK is consultant-led specialism; and many NHS job postings will have FRCPath as a requirement for doctors who are not on the Specialist Register.  FRCPath Part 1 breakdown  FRCPath Part 1 is the first exam in the Royal College of Pathologists qualification. It is broken down into three sections as follows:  The three-hour exam is designed to assess candidates’ overall knowledge and understanding of histopathology or cytopathology, including the full range of autopsy practices undertaken in a district general hospital in the UK and the basic science underpinning pathology, including molecular biology.  FRCPath Part 1 delivery  In response to the challenges of the COVID-19 pandemic, the Royal College of Pathologists has migrated the FRCPath Part 1 exam online.  This means FRCPath Part 1 may be taken from the comfort of your own home. This development allows the College to continue to offer the FRCPath Part 1 exam to both UK trainees and overseas pathologists.   For full details about the online FRCPath Part 1 exam, please see our blog here.  Eligibility  Candidates for FRCPath Part 1 will generally require experience of Histopathology specialty training to reach the standard required to pass the exam. The Royal College advise that candidates take this exam after one year of specialty training.  Exam dates, applications and cost  The cost of the exam is £673 and the exam are usually held twice a year, in spring and in autumn/winter.  Applications for each sitting open a few months prior and close after around 6 weeks. While waiting for exam dates to be finalised the College advise that candidates should apply early and will be able to withdraw their application for a full refund should the date be unsuitable.  For up-to-date information on exam and application dates, keep an eye on the College website here.  Preparation  There are many resources available to help you prepare for your FRCPath Part 1 exam. As always, we recommend that the best starting point for your study is the Royal College website, particularly the Curriculum for Specialty Training in Histopathology. Your exam is based on this curriculum so familiarising yourself with it as soon as possible will give you the best chance of success.  Other helpful resources for your study include:  Regulations and guidelines – before applying for FRCPath exams, the College recommends you read both the general and specialty-specific regulations and guidelines, found below:  General Regulations and Guidelines  Histopathology Regulations and Guidelines  Social media study groups – there are multiple study groups available across different platforms such as Telegram, Facebook, and WhatsApp. IMG Connect hosts study groups for FRCPath Part 1 – these forums bring together overseas histopathologists in one communicative, constructive, and moderated space for learning, sharing, and support.  If you are interested in joining the IMG Connect FRCPath Part 1 study group, please email info@imgconnect.co.uk to speak to request your admission.  Online courses, videos and other resources - there are some great online courses and resources available to prepare for the FRCPath Part 1 exam. These include everything from full mock exams to flashcards and YouTube videos. We’ve compiled all these which you can access here, through our IMG Resources library.  FAQs - There is also a Frequently Asked Questions (FAQs) document which the Royal College has compiled to help applicants who have questions about online examinations. You can read this here.  #IMG Tips  Prepare early – getting your revision going as soon as possible will help you avoid those last-minute cramming sessions and increase your chances of passing first time.  Speak to your colleagues and peers – there are so many study materials to choose from - who better to ask for recommendations than histopathologists who have been through the process or are going through it with you?  Familiarise yourself with the online format – there’s no bigger headache than a bad connection – go through your IT checks well in advance to avoid (most) hiccups on the day  Join the online histopathology community – connect with like-minded histopathologists and dedicated pathology recruiters in the IMG Histopathologists Facebook group.  I’ve passed the FRCPath Part 1 exam, what’s next?  Congratulations – this is a massive achievement! After a well-deserved break, it’s time to look forward to FRCPath Part 2. For more information on the final exam in the examination suite, take a look at our blog where we explore FRCPath Part 2 and everything you need to know about how to sit the exam, including syllabus, dates, results, fees and preparation.  For more useful blogs & articles on the FRCPath exams, registrations & qualifications to help you find your dream job in the NHS - take a look at our IMG library.  Follow us on social media for news and updates on GMC registration, the Royal College and NHS through the links below:             

Overseas histopathologists wanting to secure a job in the UK via the postgraduate qualification route will need to attain Fellowship of the Royal College of Pathologists in Histopathology or FRCPath in Histopathology, a sub-specialty exam of FRCPath. FRCPath is the UK qualification and a GMC-recognised postgraduate route. International Medical Graduates (IMGs) from any country in the world can sit the sub-specialty FRCPath in Histopathology examinations, provided certain eligibility criteria are met. These are summarised below along with a broad look at the following topics: What is FRCPath in Histopathology? Eligibility for overseas doctors FRCPath in Histopathology structure and format FRCPath in Histopathology: Part 1 - MCQ/EMQ FRCPath in Histopathology: Part 2 - Practical Examination As an overseas candidate where can I take the exams and how much will it cost me? How do I apply? How to prepare and what resources are available? Passed? What next? What is FRCPath in Histopathology? Set against the Curriculum for Specialty Training in Histopathology, the examinations are designed to recognise histopathologists close to the end of their training who can demonstrate sufficient knowledge and technique for independent practice. In other words, completion of the full set of exams (Part 1 & 2) demonstrates your ability to work at consultant level. Eligibility for overseas doctors: Below we outline the eligibility for overseas doctors looking to sit both FRCPath Histopathology exams. For international candidates, the eligibility criteria for FRCPath specialty examinations can be a little confusing when looking online so IMG Connect spoke to the Royal College directly in an effort to clarify this. Time spent in histopathology training is stated as a requirement of eligibility and the Royal College do consider equivalents to NHS training programmes though there is no list of countries with accepted or unaccepted training programmes. The royal college advises you should speak to your Educational Supervisor or Sponsor (if you have one) who can advise you if you are ready or eligible to sit the Examinations if you are unsure. Remember, there are many overseas doctors applying for all parts of the FRCPath exams so don’t be put off applying! Top Tip: If you have the required months training in a recognised programme in your country for Histopathology specifically, the chances are you will be eligible. Eligibility for Part 1:You are required to have trained in a recognised training programme in Histopathology for a period of no less than 12 months.  Did you know? Candidates who have passed the FRCPath Part 1 examination in Histopathology who, after appropriate training, can attempt the Part 2 examination in one of the following: Forensic Pathology, Neuropathology or Paediatric Pathology. Eligibility for Part 2: The Royal College expects you to have at least three years of specialty training specific to Histopathology in your own country. Furthermore, the Royal College strongly advises candidates to attempt Part 2 at least 12 months after passing Part 1. FRCPath in Histopathology structure and format: The FRCPath examinations consist of two parts: Part 1 – One paper comprised of 125 multiple choice questions (SBAs and EMQs) Part 2 – six-part practical examination held over two consecutive days. Part 1 examination: FRCPath Histopathology Part 1 One comprises of 125 multiple choice questions in both single-best-answer (SBAs) and extended-matching-questions (EMQs). The exam is orientated towards assessing your overall knowledge and understanding of: histopathology/ cytopathology basic science underpinning pathology (inc. molecular biology) full range of autopsy practices undertaken in an NHS District General Hospital Part 2 Practical Examinations: The exams consists of six components taken over two days, summarised below: Part 2 Practical examinations Surgical history 20 cases in 20-minute slots Cytopathology 8 cases in 20-minute slots Macroscopic pathology 4 cases with 20-minute reviews followed by 20-minute discussions OSPEs 2 20-minute stations Long cases 4 20-minute stations Frozen sections 6 cases in 2, 20-minute stations. One meeting with examiners in separate 20-minute station. Surgical history: 20 cases are provided in 10 pairs of haematoxylin and eosin (H&E) stained slides in 20-minute slots over 3-hours 20 minutes of the second morning. The cases will represent a range of difficulties, with some proving complex cases requiring detailed description, differential diagnosis and special techniques or cases not diagnosable on a single H&E. Cytopathology: Held on the first morning of the exam. Eight non-gynaecological cytology cases will be provided in pairs in 20-minute slots. Macroscopic Pathology: This part is designed to allow candidates to demonstrate their capabilities in discussing gross pathology and familiarity with block selection in the context of the RCPath Minimum Datasets. Four cases provided in the form of photographs of gross pathology specimens. Two 20-minute slots will be provided for 2 cases, followed by 20-minute discussions with 2 examiners.  OSPEs: 2 x 20-minute stations. One of which is conducted face-to-face with 2 examiners while the other is a written exercise only. Possible topics can include management/clinical governance type and MDT type cases. Long Cases: 4 x 20-minutes stations provided on the first afternoon including cases which cannot conventionally be covered in a single H&E stained section. Frozen Sections: 6 cases viewed in 2 x 20-minutes stations (3 cases per station) before meeting with a pair of examiners in a 20-minute station. You need to take notes and be able to provide the examiners with a bottom-line diagnosis only, to form basis for discussion in face to face meetings. Where can I take the exams and how much will they cost me? The COVID-19 pandemic has caused disruption to Royal College exams across all specialties, and unfortunately the RCPath exams have been affected also. For the most up-to-date news on the RCPath examinations please refer to their website here. FRCPath Part 1 (current COVID-19 arrangements): In 2022, the Part 1 examination will be offered using online delivery to candidates. This means you can take the exam remotely and will not need to travel overseas to sit the exam, or attend an examination centre. The College will deliver the written components of these examinations through a company called TestReach, the Oral components (including oral OSPE stations) will be delivered using a video-conferencing platform such as Zoom or Microsoft Teams and for the written examinations, candidates will be given the opportunity to trial the TestReach system to familiarise themselves with it ahead of the examination. You can read more about the new, remote examination process further here on our website. Previously, the Part 1 examination was sat in multiple overseas centres and once the pandemic is under better control globally, it is highly anticipated the Royal College will return to previous set-ups. The FRCPath Part 1 exam costs £622. You can see how the Royal College breaks down the cost here on their website. FRCPath Part 2 (current COVID-19 arrangements): Part 2 exams will be held in person in the UK in 2022. There will be no online delivery for the exam. Keep an eye on the RCPath website for the most up-to-date news on the exams. The FRCPath Part 2 exam costs £1,308. You can see how the Royal College breaks down the cost here on their website. How do I apply? Applications must be made via the Royal College of Pathologists website, with applications only available once an application window is opened by the Royal College. This is usually twice a year, in SPrin and in Autumn. How do I prepare for RCPath exams and what study resources are available? With lots of resources available online, we have discussed with consultants the best place to start looking for materials relating to the exams. Most recommended starting with the Royal College, who have created useful resources to help you to prepare for the exams.  Curriculum: Questions are set against the Curriculum for Specialist Training in Histopathology We recommend getting to know the curriculum as early as possible and using it as a road map for your study plan.  Regulations and Guidelines: Before applying for FRCPath examinations, the Royal College recommends you read both the General & Specialty Specific regulations and guidelines: General Regulations and Guidelines Royal College - Histopathology Regulations & Guidelines Sample Questions:Testing yourself against previous exam questions is always a recommended way to prepare. Histopathology Part 1 sample questions Cancer Datasets and Tissue Pathways: The College’s datasets for Histopathological Reporting on cancers have been written to help pathologists work towards a consistent approach for the reporting of the more common cancers and to define acceptable practices in handling pathology specimens. Whilst these are not specific to FRCPath examinations they are certainly relevant to the wider practice in histopathology. IMG Connect advice: Part 2 – food and drink:With multiple exams taking place for Part 2 in one day bring supplies! It will be a long day and there may not be access to food. Hiring a microscope: For Part 2 you will be required to sit examinations in the UK and will require a microscope. The examination centres will not provide equipment for any applicants so you will need to hire a microscope in advance. There are a few companies easily accessible through a web search, find a microscope and book well in advance of the exam. You can arrange for the company to drop off and pick up the microscope from the exam centre, don’t worry! I passed the FRCPath exams! What next? First of all, congratulations! After you have passed both parts of FRCPath in Histopathology you can apply for a full registration with a license to practice. Once the GMC have approved your application, you can work as a histopathologist in the UK.  Don’t hesitate to get in touch with an IMG Consultant to discuss UK job options in Histopathology, including discussions regarding a typical doctor salary in the UK and the most suitable locations for you.  The Royal College makes it clear that individuals who reach the standard required to pass the FRCPath examination in their chosen specialty are deemed to have the necessary professional competence to practice unsupervised. FRCPath also greatly contributes to the Certificate Confirming Eligibility for Specialist Registration (CESR), the alternative route to the Specialist Register for doctors who do not complete their training in an approved UK training programme.  Follow us on social media through the links below for regular news and updates on the Royal Colleges, relocating to the UK and working in the NHS: