Summary of "FRCPath Part 2 Histopathology Webinar"
Main ideas / lessons conveyed
Purpose and exam overview
- The speaker (Dr Sarah Lowa) introduces the FRCPath Part 2 histopathology webinar to:
- Explain what is included in Part 2
- Align candidates on what they will be undertaking in the April exam
- Provide hints/tips on approach
- Allow time for questions via Q&A
- The exam spans two days and requires candidates to pass all components.
- Pass mark: 50% in each component.
Surgical pathology component (most emphasized)
- 20 cases total
- Covers a wide range of systems, blueprint-aligned to the curriculum.
- Reflects a district general hospital (DGH) generalist workload, typically including:
- A mixture of malignant, non-malignant, and infectious cases
- Emphasis on common subspecialties (e.g., skin, GI) based on real case frequency
- Format:
- Cases are presented in pairs
- 2 cases per 20-minute slot
- Expected time per case: about 10 minutes
- Candidates must screen both slides within that time
- Difficulty level:
- Case selection is consensus-based (not “bizarre/weird” diagnoses)
- Roughly at NST4 level (typical of ~4 years training)
Methodology / approach for surgical pathology answers (detailed)
During the 10 minutes per slide/case
- Read the clinical history first
- Use it to form “pre-slide” expectations and guide targeted feature scanning.
- Quickly view both slides
- Identify which one is likely straightforward vs the one that may take longer.
- Don’t spend excessive time: aim to screen each slide in about 1–2 minutes.
- For each case, follow the workflow
- Make a list of macro/micro features you can see.
- Build a differential diagnosis list:
- Include and exclude diagnoses based on observed features.
- Start writing early—don’t wait until the end.
How to lay out surgical pathology written answers
(Recommended structure; similar for surgical pathology “shorts” and “longs”.)
- History
- Include age, sex, location, clinical impression
- Not strictly mandatory, but recommended to avoid missing key context (as highlighted in Q&A).
- Micro description
- Written like a routine histopathology report.
- Diagnosis or differential
- Provide a preferred diagnosis (if using a differential).
- Additional work / actions
- What extra tests you would need to authorise/sign out
- Include polls/comments or additional statements that demonstrate knowledge
- Conciseness
- Generally no more than ~1–2 pages.
- Legibility
- Poor handwriting reduces the ability to award marks.
Marking principles (surgical pathology and generally)
Closed marking scheme
- Marking is centrally set and centrally marked, with consensus and cross-checking.
- This is a “closed marking scheme”:
- Your answer is assessed against what is expected for that specific H&E slide/case.
How marks are conceptualized for each case
- The scheme uses value bands such as:
- 4 = top level (highest value in that scheme)
- 2.5 = pass mark
- 2 = borderline fail (safe-ish but not the correct diagnosis)
- 1 to 1.5 = fail (unsafe/insufficient)
- 3 to 3.5 = correct diagnosis/differential plus added value
- Pass threshold: 50%
- Double marking:
- Papers are double marked independently at central marking
- The same strict scheme applies to all candidates.
Time/magnitude of scoring
- Limited points are available, and scoring gaps often relate to added value rather than just basic correctness.
- Overall message: the exam is designed to be fair and blueprint-aligned, not trick-based.
Other exam components described
Diagnostic cytology component
- Not set by the main speaker personally, but described:
- 8 cases total
- Presented as paired cases
- 2 cases per 20 minutes
- Pairings may be described as slightly easier/harder depending on the set.
- Centrally set and centrally marked with a strict marking scheme.
Macro component (OPies / gross pathology)
- 4 cases, arranged as groups of two
- You are given photographs and written questions during prep time.
- Marked in the discussion (viva-like):
- 40 minutes total prep (10 minutes per case)
- 20 minutes speaking with examiners about the four cases
- Tests gross pathology skills and minimum data set knowledge.
- Examiners mark based on:
- Viva/vocal performance
- Your responses to the question set
OSCE-style viva sections and macro “OP2”
- OS1 (management/clinical governance related viva)
- Scenario-based
- One scenario with multiple leading questions (Q&A confirmed ~4–6 questions from one scenario)
- OP2 (written short paper)
- Short written questions about data sets, T/M/M molecular tests, etc.
- Based on scenario flow and patient pathway style questions
Long cases
- 4 long cases, 20 minutes per case
- Typically includes:
- A renal case
- A liver/soft tissue/lymphoma-type case
- Others (not guaranteed, but common patterns were stated)
- Provided with:
- H&E slides
- Additional provided material (e.g., IHC, molecular, EM possibilities)
- Marked via a similar strict centrally set scheme.
- No separate viva component for long cases (as described): marking is integrated.
Frozen sections (viva)
- 6 cases, in groups of three per 20 minutes
- 20-minute viva with two examiners after prep
- Your vocal responses are marked
- Deferral guidance:
- Marking schemes allow some deferral
- But examiners expect cases chosen to minimise the need for deferral.
- Style guidance:
- Provide a short description and a bottom-line diagnosis
- Intended to be answered as though speaking to the surgeon
Practical rules emphasized in Q&A (important)
Use of electronic devices and timers
- Day 1: no electronic devices allowed all day.
- Day 2: electronic devices allowed at lunchtime.
- Timers are allowed if non-noisy.
Which sections occur on which day
- Day 1: long cases, OS1, frozen sections, and cytology (in two half-day blocks)
- Day 2: short surgicals, Macros & OP2
Expected level of “definitive diagnosis” vs differential
- Frozen sections:
- Prefer definitive diagnoses or safe “umbrella brackets”
- Avoid extreme/major uncertainty
- Examiners may push for refinement
- Short surgical pathology:
- Expected to give a preferred diagnosis, even if a differential is acceptable
- Differentials matter when multiple entities are plausible on H&E alone
- Time limits mean you generally cannot produce many extensive separate differentials—choose what is most relevant.
Tables for IHC/molecular planning
- If proposing IHC, put markers into a clear table:
- Marker names across the top
- Expected positive/negative pattern by differential
Slide handling and limited time
- Slides do not return after the slot ends.
- During rest stations:
- You may not add to written materials (rest is for rest only)
- Staggered rest times mean later additions would be unfair.
When you can “add” later
- If you finish earlier with long case 1 and then move on:
- You can return to improve your earlier work during the allowed writing time
- But you cannot reopen slides once they move to other candidates.
Strategies to gain extra marks (examples given)
- Correct diagnosis alone may not always achieve the highest bands.
- To move beyond pass-level:
- Add relevant minimum data set items
- Add additional tests you would do in practice
- Include treatment/follow-up implications
- Example described (interpreted from transcript around “malak” and a CIS context):
- Get the correct diagnosis
- Then add supporting/confirmatory testing (e.g., mention of a stain approach)
- Add etiologic knowledge (e.g., repeated infection association)
- Add consequences for clinicians (e.g., significance of underlying malignant processes)
What counts as “vital errors” (safety-focused marking)
- Errors that could significantly change management or risk harming a patient can drop scores sharply.
- Classic described scenario:
- Benign case labelled malignant (or malignant differential treated as primary thinking) → could trigger unnecessary major surgery/therapy.
- “Less harmful” diagnostic mistakes may still score higher if they don’t strongly change patient treatment (e.g., borderline/safer categorisation).
Guidance on reporting systems (Q&A)
- Use UK-appropriate approaches:
- The exam aligns with College datasets and TNM-like frameworks as used in the UK context.
- Recommendation: use the College exam datasets systems rather than non-UK ones.
Exam resources / portals
- The speaker references the College pathology portal (not ROAL):
- Requires registration
- Contains uploaded exam resources
- Includes practice materials (e.g., short surgicals from recent sittings).
Speakers / sources featured (as named in the transcript)
- Dr Sarah Lowa — Consultant histopathologist; Lead examiner for FRCPath Part 2 (primary speaker)
- Helen — Another presenter/colleague referenced frequently (e.g., cytology-related handling; surgical approach contributions)
- Royal College of Pathologists / College pathology portal / Royal College website
- Curriculum access
- Datasets and exam resources
- Practice/case portal materials
- Infirma guidance / Infirm(a) London
- Mentioned as a place Dr Lowa consults for lymphomas (practice approach referenced in passing)
Category
Educational
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