Intended for healthcare professionals


How to succeed in your histopathology application

BMJ 2016; 355 doi: (Published 13 December 2016) Cite this as: BMJ 2016;355:i6301
  1. Mariam Masood, specialty trainee year 11,
  2. Catherine Horsfield, consultant histopathologist2
  1. 1Royal Sussex County Hospital, Brighton and Sussex University Hospitals
  2. 2Guy’s and St Thomas’ Foundation Trust
  1. mariammasood{at}


Doctors wishing to specialise in this increasingly popular area need to have good research skills, say Mariam Masood and Catherine Horsfield

Histopathology is rapidly becoming one of the more competitive specialties, with the number of applications for training posts steadily increasing. In 2015-16 there were 189 applications for 79 posts, giving a competition ratio of 2.39 compared with a ratio of 1.3 in 2013, and 1.8 in 2014.1

Histopathology is the study of diseased tissue. Histopathologists diagnose diseases from surgical specimens using methods ranging from basic microscopy work to immunohistochemistry. We also conduct autopsies. It is the variety that this specialty offers, as well as the interface between diagnostics and fast paced technology, which makes it an attractive option.

Medical students and foundation doctors have little exposure to histopathology and students with an interest are advised to take a special study module. Doctors should consider applying for a “taster week,” attending post-mortem examinations at their hospital, and speaking to current histopathology trainees.

Essential skills include a broad based medical knowledge as well as good attention to detail, as diagnosis rests on this. Good communication skills are needed in order to share findings with other professionals.

Histopathology is a research focused specialty and evidence of academic skill is an important part of the selection process. You will need to demonstrate an understanding of the audit cycle and show experience of an audit.

The application

The Royal College of Pathologists uses the national recruitment system, Oriel. The application form covers four themes: experience and commitment to specialty, clinical knowledge, academic achievements, and personal skills.

The interview

The interview consists of six stations, lasting five minutes each, and a 30 minute written station. You will be asked to prepare a portfolio of evidence that includes your CV, degrees, prizes, audits, publications, evidence of commitment to specialty, and any letters of recommendation.

Portfolio station

The consultants will have been given your portfolio in advance and you should be prepared to answer any questions that may arise from it. Your commitment to the specialty will be tested at this station. Your answers should reflect your enthusiasm and the effort you have undertaken to maximise your exposure to histopathology.

Team work

Here you will show your understanding of the histopathologist’s role. We regularly work within our own teams as well as with other clinicians. You may be questioned on your understanding of the concept of teamwork and asked to provide examples.

Clinical knowledge

Here you will be presented with a clinical scenario in order to assess your diagnostic approach as well as your knowledge of pathophysiology. You should be prepared to answer questions on the spot. The cases will be based on straightforward topics, such as heart failure or asthma.

Quality and risk

This station is split into two parts. First, you will be presented with an ethical scenario, similar to cases seen in the Situational Judgement Test. Reading the Good Medical Practice ethical guidelines will put you in good stead.2

Secondly, you will be assessed on your understanding of the audit cycle. You should be prepared to discuss an audit you carried out. You must elaborate on what you learnt from it and what you might have done to improve the process in the future. This will make your answer stand out from other applicants.

Case study

You will be given enough time to prepare for a case study that will be presented to a panel. The aim is to show understanding of the role of a pathologist and its relevance to a layperson. You will be provided with a sheet of acetate and pens to facilitate the presentation.

Written station

At this station, you will be given 30 minutes to read a clinical summary of a deceased patient and prepare a cause of death with a short written piece that explains your rationale. This will be similar to cases you will have come across as a foundation doctor when going to the bereavement office.


  • We have read and understood BMJ’s policy on declaration of interests and declare that we have no competing interests.