Pathways to Excellence | Winter 2022

Pathways to Excellence URMC DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE | WWW. PATHOLOGY. URMC. EDU | WINTER 2022

As the diversity and inclusion officer for Pathology, Dr. Bradley Turner is leading a new committee to help identify and address areas of improvement in the workplace.

listening and learning together Bradley Turner, M.D., M.P.H., M.H.A., Leads New Departmental Faculty & Staff Diversity Committee The murder of George Floyd in the spring of 2020 sparked a national social justice movement followed by activism across the United States.

As part of its institutional response, the University of Rochester implemented a five-year equity and anti-racism action plan (EARAP) that outlines several ways to work toward a mission of establishing an anti-racist infrastructure. One facet of the plan is designating a Diversity and Inclusion Officer (DIO) in each department to serve as a liaison to the University’s Office of Equity and Inclusion.

Dr. Bradley Turner, one of two department faculty who identify as African American, volunteered to take on the role of DIO. Knowing the importance of this mission, he formed a new Faculty and Staff Diversity Committee (FSDC) to provide structure and

recommendations surrounding diversity and inclusion in Pathology and Laboratory Medicine.

The FSDC’s mission focuses on identifying issues that affect the culture and climate within the department to enhance cultural awareness and sensitivity. It has a particular focus on recommending ways to attract, retain and promote cultural competence among a diverse group of talented leaders, faculty and staff.

WHAT THIS MEANS A DIO is the department’s first point of contact concerning issues of diversity and inclusion. They are not the human resources representative and do not make any formal recommendations to employees. Rather, their conversations with employees are confidential and documented. If the employee desires, these Continued on page 2

IN THIS ISSUE Diversity............................................................................ 2

Digital Pathology............................................................... 4

From the Chair.................................................................. 3

Education News................................................................ 5

Save the Date.................................................................... 3

Focus on Faculty................................................................ 6

LISTENING AND LEARNING TOGETHER

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concerns are formally reported to the UROEI for follow up. guiding external recruitment efforts, the FSDC is focused on Evidence-based literature increasingly suggests that diverse cultivating an environment where everyone is treated equitably workplace environments perform better than those that lack diversity. and involved in decisions that affect their well-being.

Issues linked to diversity are top-of-mind within the department of From a recruitment perspective, Vicki Roberts, director of the more than 1,100 employees who represent a wide range of ethnic, medical technology training program who also sits on the FSDC, says gender and socio-economic backgrounds. Turner points out that while striving for greater representation will benefit everyone long-term. race is often a significant factor in these discussions, it’s also important “When we seek to educate, recruit and retain talent that to acknowledge a multitude of other factors like gender, sexuality, represents a wide array of backgrounds, the final product is deep, disability and hierarchy in the workplace. relevant and authentic,” said Roberts. “It enriches our work culture But even a work environment that’s perceived as diverse still has and environment at the University where all people can feel at room for improvement. to be more equitable and inclusive. As Turner home. This promotes retention, but more importantly encourages points out, “You can have a diverse department that’s not equitable a good sense of well-being in our spaces.” or inclusive where competent and qualified individuals may not be equitably mentored or included in workplace decision making.”

EQUIPPED TO SERVE This can often lead to a cycle in which the same people who provide Since taking this role, Turner has done quite a lot of listening diversity perceive or experience lack of growth and advancement, and – largely informed by his own work in the community. Turner, a leave even the most well-meaning organizations. If the root causes go breast and gynecologic pathologist, is heavily involved in several uncorrected, this cycle of recruitment and attrition can continue. charitable organizations. He is a board member and past treasurer At a high level, the FSDC acts in an advisory role. The committee of the Black Physicians’ Network (BPN) whose most recent convened in January 2021 and since then has begun gathering efforts help medical students from underrepresented backgrounds feedback from all employees. Their first employee survey received through scholarship fundraising, academic networking and hundreds of responses which the committee reviewed individually. confidence-building interactions with other physicians of color.

They will use this data to “One of the issues for many “You can have a diverse department that’s identify areas of need and make underrepresented minorities is that not equitable or inclusive where competent and actionable recommendations when an individual is perceived or to the Chair. While sweeping qualified individuals may not be equitably mentored feels like the ‘only one,’ it can be an change won’t happen overnight, obstacle for a number of reasons,” or included in workplace decision making.” you have to start somewhere, said Turner. They may lack proper - Bradley Turner, M.D. explained Turner. mentoring or be excluded from “An organization has to first accept and embrace that there are workplace decision making which can lead to self-isolation, and, “This problems and acknowledge that some cannot be solved in the combination of conscious and unconscious bias and isolation exaggerates short term,” he said. “It must be willing to objectively accept the a cycle of exclusion.” results, even when the results expose embarrassing truths.”

To help expose young students to career opportunities, Turner, It’s not enough to simply identify problems, he continued. The who is a founding board member of the Academy of Health organization must make strides to address them with outcome Sciences Charter School in Rochester, also serves as the school's measures for success. health sciences liaison for health sciences. Pre-COVID, he coordinated visits to the UR Medicine Central Laboratory at Bailey MAKING STRIDES Road, where students in grades 5 to 8 could see the work of the As an institution, URMC has already taken steps to improve clinical laboratory and learn about careers in the field from faculty upon a spotty legacy. Last summer CEO and School of Medicine and staff.

Dean Mark Taubman, M.D., authorized the removal of the name He is also involved in fundraising with the fraternal organization, of founder George Whipple, from public spaces. Whipple was a Sigma Pi Phi, whose local chapter, Gamma Iota, gives scholarships pathologist whose renown was marred by overt racism after he through its non-profit foundation together with the Urban League. resisted admitting Black students to the medical school.

His passion for encouraging education and representation is The medical school has also recently introduced new something he hopes to use at URMC as the Pathology diversity and scholarships for Black students and pledged to prioritize similar inclusion officer. But real progress starts with being willing to listen, strides toward equitable admission moving forward. Our Turner says. department also recognizes the importance of cultivating a “When you listen and try to understand someone else’s point of diverse learning environment as a precursor to the workplace. view, you often gain insight into their motivation. Although you One example is a new financial scholarship to our medical may still disagree, this insight provides an opportunity for more technology training program that’s available to students from effective communication. This is critical to building successful underrepresented backgrounds. relationships that value diversity, equity, and inclusion.”

Whether it’s identifying areas of improvement internally or 2 URMC DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE

FROM THE CHAIR

H

Bruce Smoller, M.D.

"This move is clearly a once-in-a-generation opportunity for the department to re-organize itself for the modern medical center, which does not look (or feel) anything like one from the days of yore."

appy New Year! As I sit here and gaze outside at a cool, grey, rainy day in December I am delighted to have a few minutes respite to compose this note to all of you. We are in the midst of a very busy period. Attempting to work around the COVID pandemic (and whatever the number of the surge is, at this point), we are busily interviewing candidates for our residency and fellowship positions. We will interview more than 50 medical students for the four spots in our upcoming match, and I am pleased to tell you that the candidates with whom I have visited are excellent!

Our fellowship positions are all filling quickly with excellent candidates. In addition, there is the never-ending expansion of our faculty as we attempt to keep up with the continuous growth of the UR hospital network. We have successfully recruited five new members of the team about whom I will share more in a subsequent newsletter.

The plans for the re-location and backfill of our non-urgent anatomic pathology programs to Bailey Road continue on pace. The architectural firm is working closely with our AP leadership team developing plans to move histology, grossing, immunohistochemistry, cytopathology, and perhaps autopsy pathology to the planned expansion of the building at Bailey Road. This will free up much-needed space at Strong Memorial Hospital, into which parts of hematopathology, tissue typing and flow cytometry will expand.

All of this needs to happen without in any way detracting from our residency training program, so space for our burgeoning educational programs—medical technology, cytotechnology, phlebotomy, and our residents and fellows—must also be built into the project. While the plans are not yet finalized and will undoubtedly be affected by budgetary constraints, we are quite optimistic that the department will be able to plan and build for the future.

I am happy to report to you that Drs. Bin Zhang and Zhenqian Yao were both promoted to the rank of Associate Professor in recent months. Congratulations to both of them for an honor well deserved. The department continues to thrive financially, as well as in terms of the service we provide to our clinical colleagues and we continue to be highly regarded by other departments and the institutional administration. This is based upon the incredibly hard work performed by our faculty and staff under the most difficult of circumstances. Thank you to all, and again, Happy New Year!

SAVE THE DATE JOIN US AT USCAP 2022!

We are pleased to host alumni and friends at a special reception during USCAP meeting this year in Los Angeles. We would love to see you! The reception will be held on Monday, March 21 at 5:30 p.m. For location and other information, email Leslie_Antinarella@urmc.rochester.edu. RSVP’s are appreciated but not required for this event.

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SLOWLY BUT SURELY, DIGITAL PATHOLOGY TAKING OFF AT URMC In an increasingly digital world, will glass slides and WHERE ARE WE NOW? microscopes grow obsolete? The short answer is probably— We as an institution are just getting into the game but we’re not there yet. when it comes to WSI, and becoming fully digital will With the emergence of digital pathology, whole take time. One challenge is available equipment. URMC slide imaging (WSI) and assistive technologies that help currently has some microscope scanners that can scan a few pathologists work more efficiently, we are inching closer to dozen slides at a time. The next step will be purchasing a going fully digital in everyday practice. Vektra Casler, M.D., scanner that can scan 10 times the number of slides. director of our new Informatics division, is leading the effort Perhaps the greatest challenge, however, is the sheer size to gradually incorporate WSI into certain subspecialties. of the data. For example, one scanned slide is 1.5 gigabytes Whole slide imaging – which is as large as a full is a method in which glass movie, Casler explained. slides are placed under Like other outside a camera microscope institutions that have that captures images that hundreds of terabytes of can then be viewed on a storage, we hope to follow suit computer screen. From by getting a central server to there, the images can be host the files so they are not easily saved and shared only easily accessible from virtually for diagnosis, and anywhere but stored securely virtual consultation, as for years to come. Digital well as teaching purposes. pathology will not only This not only alleviates strengthen and streamline the burden of transporting patient care, but teaching John Plavnicky of Cytopathology demonstrates the Hologic Genius, which slides back and forth opportunities as well. performs digital whole slide imaging. between institutions (or “This foray into WSI even across the hall) but has and getting our feet wet into digitizing is going to open a door potential to change how pathologists do their jobs. The end to teaching sets and research so we can do our job better in the goal of becoming all-digital is still years away, she explains. future,” said Casler.

“The goal of diagnostic medicine overall is to have all the puzzle pieces at your fingertips so you can render CYTOPATHOLOGY TAKES A TEST DRIVE a diagnosis quickly and as best and efficiently as you John Plavnicky, chief supervisor of Cytology, recently can,” said Casler. “We want to digitize as many aspects as gave a quick tutorial on a new digital scanning instrument possible so the pathologist and the slides don’t have to be in called the Hologic Genius. The instrument performs whole the same room.” slide imaging on gynecologic specimens, and though it’s The benefits of WSI are two-fold. In addition to currently being used in Europe, it’s still awaiting FDA providing greater portability, going digital allows the user approval in the U.S. Plavnicky’s team is working in to apply artificial intelligence (AI) to the scanned image. conjunction with the vendor to use it for research in the While computers aren’t going to make them obsolete, this meantime, making URMC one of the first institutions in kind of AI can help set the stage for the pathologist to the country to experiment with the Genius. make a final diagnosis.

To start, they are running about 500 previously-tested “AI is never going to be completely in the driver seat,” samples on the Genius and re-screening slides to compare said Casler, who compares the pathologist to a pilot flying results to microscope-based diagnoses – very much like a plane with help from a GPS and radar. “You have a very a “double-blind” study. In future studies, they will likely real responsibility and if you misdiagnose a case, somebody simplify the process and compare the instrument’s findings could die or have their life change forever.” to the known diagnoses.

Because a computer is very fast at doing mundane The Genius works after samples are loaded into the things, AI can identify visual hotspots and immediately machine, which then captures a scanned image of each pinpoint potential areas of concern on the scanned image so slide and saves it to a server. The image is then viewable on the pathologist can zero in on those areas. The result is a nice a separate computer monitor from virtually anywhere. The pairing of detection software, which is highly sensitive, with software program then applies rapid detection to certain an expert pathologist, who is highly specific. Both can help fields of view on the image, highlighting areas that could the latter work more efficiently by saving time and tedium contain cells of interest. that comes with traditional microscope-based practice.

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“If it works, it’ll increase the flexibility in when and where screening is done,” said Plavnicky. Right now, the process of slide examination is laborious. Each slide has to be physically moved from a prep area to a cytotech, then to a pathologist, and finally placed in a storage area. Going digital removes some of these (literal) moving parts.

“Now we’re limited to where we can sign these out because the scope has to be connected to the imager,” he said. “That would go away with this system because it’s

linked to a server accessible anywhere.”

As a longtime cytotech who spends many hours at the scope, he said the prospect of going digital is a big shift. But it’s not as big of a leap as you’d think.

“It feels strange in a field that revolves around microscopy. Not that it’s going away,” he said, pointing directly at the microscope within the machine itself. “The technology is not necessarily removing it. It’s removing the way it’s utilized.”

FOCUS ON FACULTY of the Finger Lakes year-round.

Clinically speaking, autopsy and neuropathology are incredibly diverse subspecialties that require a vast pool of knowledge, and Bharadwaj is quick to point out the low threshold for consulting each other among the faculty.

He says working in such a supportive and collaborative environment is very gratifying. “No matter how long you’ve been a pathologist, something new will always come to you–something that doesn’t fit into any of the boxes,” he said. “I find that very exciting.”

When he isn’t on service or conducting research,

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Bharadwaj enjoys teaching medical students as well as Pathology and Ophthalmology residents. His future goals are to expand his research lab, which is currently running basic research with fruit flies, and hopefully pursue translational studies with human tissue in the future.

He is married to Shilpa Vyas, M.D., a radiation oncologist at Rochester Regional. They live in Pittsford with their son, Aarav, 7. Outside of work, his hobbies include photography, spending time outdoors and traveling with his family. “My other passion is reading, mostly fiction,” he says. He enjoys both classic and contemporary literature.

EDUCATION NEWS OUR DIFFERENCES ONLY MAKE US STRONGER Our department is a wonderful melting pot of folks from is very easy to encounter students who grew up far from diverse and different backgrounds. We can all look around Rochester where they now make their home. Learning from our workplace and realize that our colleagues often come these trainees should be an opportunity for all. Research from different backgrounds, or hold different would suggest that our differences only views from ourselves. These differences make make us stronger and can even give us a us better, giving us a chance to see the world competitive advantage. from a different perspective and strengthen Our diversity extends as far as how we learn the care of our patients. and grow academically. An interesting trend I find that our students tend to encourage is starting to take hold in resident education: us to grow and develop as we consider moving from time-based to competencyothers. So often in medicine we learn based medical education. Entrustable disease processes based upon the archetypal Professional Activities (EPAs) essentially boil presentation in the archetypal patient. But down to what tasks or responsibilities can so very often, this is not who we encounter. be handed over to a trainee once they have Jennifer Findeis-Hosey, M.D. In my work with the medical school, I find demonstrated that they have the right set of that it is often the medical students who point out when knowledge and skills. As one can imagine, not everyone we may have missed the mark, challenging us to check our will reach competency in the same amount of time, and assumptions and biases. And for this I am appreciative. this is ok. Realizing there are a multitude of different ways Driven by student and faculty input, our medical school has to learn and approach a problem is important in academic recently debuted an audit tool that provides suggestions for medicine. It is up to us to reach our learners at the middle how to assess if educational materials are free of stereotypes, point, maintaining rigor while being accommodating. overgeneralizations, or biases. For any who are interested, I It is amazing to think about all the ways we are different would be glad to share this helpful guide. from each other, but still come together, learn from each And within our own departmental training programs it other, and provide medicine of the highest order.

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Department of Pathology and Laboratory Medicine University of Rochester Medical Center 601 Elmwood Avenue, Box 626 Rochester, NY 14642

FOCUS ON FACULTY RAJNISH BHARADWAJ, M.D., PH.D. Neuro and autopsy pathologist Rajnish Bharadwaj joined the faculty in late 2018, embodying the term “physician-scientist” through his work in both clinical and research settings. When he is not signing out cases, Bharadwaj, who has a Ph.D. in cell regulation, runs his own research lab that studies molecular mechanisms of neurodegeneration that has implications for disorders like Parkinson’s disease and Neurodegeneration with Brain Iron Accumulation Information (NBIA).

While at medical school in India, he became aware of the large gaps in our understanding of the pathogenesis of human diseases and became interested in basic research. He came to the U.S. to pursue graduate studies at UT Southwestern, studying mechanistic basis of aneuploidy, a hallmark of cancer. After graduate school, his dilemma was whether to go for a residency or a postdoctoral fellowship. He chose the latter because he had developed an interest in studying neurobiology using model organisms, a field that was completely new to him. He did a postdoctoral fellowship at Johns Hopkins but decided to advance his medical training afterwards, realizing that a parallel career in medicine, though challenging,

offers professional stability while opening new avenues for research.

This journey brought Bharadwaj to the Pacific Northwest, where he completed a combined AP/NP fellowship at University of Washington. He notes the similarities pathology shared with his work exploring neurodegenerative disease —albeit at a different spatial scale— during his post-doctorate studies. Pathology had many of the aspects of basic research that he found enjoyable, namely, examining disease processes under the microscope. That continues to this day. He says the importance of reaching the right diagnosis is what drives him to bring his best to every case that comes across his desk.

“What I enjoy most is knowing that I am providing extremely important information for patient care,” he said. “This can be nerve-wracking at times, especially neuro frozens, but we provide diagnoses, which require a lot of finesse and have significant consequences for the patient.”

After completing his fellowship, he was drawn to Rochester for its high neurosurgical volume that would lend itself well to his training and expertise. Another motivating factor was the opportunity to have his own lab. Upon visiting, he found that URMC had a vibrant research community and an inviting atmosphere. Indoors, at least. He jokes that making the move from Seattle meant “trading rain for snow” but says he and his family enjoy the natural beauty Continued on Page 5 URMC DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE 6