NIJ Grant Encourages Pathologists to Specialize in Forensics

While the average person may not wish to think much about death, for forensic pathologists, it’s an essential part of their jobs. The work of these critical doctors helps uncover key information to explain a sudden or unexpected death as well as any homicides under investigation by law enforcement. 

Of the more than 20,000 working pathologists in the U.S. today, there are only around 750 forensic pathologists, with about 500 to 600 of those actively working in the criminal justice system. The shortage of these important clinicians motivated the American Society of Clinical Pathology (ASCP) to offer incentives to pathology residents to pursue external rotations in this specialty. 

In collaboration with George Mason University and with funding from the National Institutes of Justice (NIJ), ASCP offered eligible medical students $6,000 and the chance to rotate into forensic pathology units across a variety of settings. 

Here, three pathology residents explain how the residency affected them professionally and personally. 

A broader understanding 

Because of the limited number of forensic pathologists, many pathology residents don’t get a lot of exposure to the specialty unless they take on a direct rotation such as the one supported through ASCP. For Dr. Ethan Powell, DO, in his third post-graduate year of residency at Alleghany General Hospital in Pittsburgh, Pennsylvania, the fellowship allowed him to broaden his experiences and help him decide if forensics was, in fact, what he wanted to do for the rest of his career. 

While a typical day during forensics rotation wasn’t any heavier of a workload than usual, it did offer him the unique opportunity to work autopsy cases for different kinds of deaths than he’d seen before, such as those by drowning and by gunshot. 

There, he was able to practice techniques such as specimen retrieval of vitreous fluid and cerebral spinal fluid, as well as evisceration, which he hadn’t had much exposure to before. 

“I was also able to observe some legal proceedings and depositions, which was fascinating to see,” Dr. Powell says. 

While the emotional component of the job can be difficult, Dr. Powell found it rewarding to communicate with families. Able to bring compassion and sensitivity to the difficult times in these families’ lives, he says, “I could tell that at the end of the conversation, after answering their questions, they feel a little bit better, which for me just really makes this specialty worth it.” 

Dr. Powell is grateful to ASCP for the opportunity, which “really solidified my interest in the specialty,” he says. He recently completed interviews for forensic pathology fellowship programs and should hear soon where he heads next. 

He encouraged other pathology students to keep “an open mind” about forensics. While on the one hand it has aspects that may seem “emotionally taxing” and “you get your hands dirty,” Dr. Powell adds, “I think that we see some of the most fascinating cases in the field of pathology and forensics is a specialty that I could see myself enjoying for the rest of my career.” 

The power of medical history 

For Dr. Mostafa Kokabee, MD, a third-year post-graduate resident at the Department of Pathology and Laboratory Medicine at Lenox Hill Hospital in New York, medical history has always fascinated him, kindling his interest in forensic pathology. 

“I always want to know the origin of why we do this or that,” he says, explaining that he loved learning about the first appendectomy in Boston in the 1860s. “He was just doing autopsies and seeing all these young people with burst appendixes, and he thought ‘Hmm, what happens if you remove that appendix?’” 

Similarly, he loved learning about how in military autopsies, young soldiers were found to have atherosclerosis in arteries, which didn’t make sense due to their age. “So, it might have been multifactorial, genetics and environment and all those things. It's just fascinating,” Dr. Kokabee says. 

When he learned about the forensic pathology residency sponsored by ASCP, he leaped at the chance to become a forensic investigator himself, an experience he doesn’t get much of in his office in New York. “I never saw the investigation teams, what they do, how they do it. We just read the report.” 

While death investigations are fascinating, they can also evoke painful emotions, both in the pathologist and when they must communicate with the family members of the deceased. 

Dr. Kokabee had already seen a significant amount of death in an earlier rotation back in Iran, and on a Native American reservation and felt like he could handle it. In the latter case, it was helpful to him that the family members of the deceased had a different take on death. “They explained that for them, death is not the end of life, it’s the beginning of another life, and the end of their suffering.” 

While Dr. Kokabee is not sure yet if he will become a forensic pathologist, he appreciates having had the opportunity to work closely in the specialty and has learned so much from the process. It validated in real time something he’d read, that as much as 70 percent of diagnoses depend upon laboratory data. 

A perfect fit 

Dr. John O. Agboola, MD, MSHS, PGY3 at State University of New York Downstate Medical Center, Brooklyn, New York, was inspired to pursue forensic pathology by a “splendid teacher” whose fascinating lectures made him curious about the field. Already trained as a surgeon, he was planning to specialize in forensic pathology when the NIJ grant “solidified that intention and made me much more passionate about the specialty itself,” he says. He finds the field “resonates with my personality and what I think I fit into most in pathology right now.” 

What Dr. Agboola loves about the specialty is that “each case is always different, which makes each day more exciting because I want to know the story behind the scene,” he says. 

He loves the process of looking at investigation photos of the crime scene, talking to the detectives and family members and then putting that all together with the pathology data. 

His background as a surgeon also helps him handle the often-challenging emotional elements. He can focus more on the questions of “how and why and the intricacies” of a case. “I want to know how we can [explain] the story from death to help the living,” he says. 

While Dr. Agboola loves the specialty himself, he does feel that it might not be for everyone. He suggests that anyone considering it “really must have passion for the job. It's not just for the money. You must have the interest and the passion and see how it fits into your ultimate goals or your personality,” he says. 

For pathologists who are still considering whether and where to specialize, Dr. Powell shares the others’ appreciation for forensic pathology, with its wide range of techniques, cases and skills, adding, “In my opinion, it's the best specialty in pathology.”