EP127: Expert Perspectives: Dr. Rosalie Elenitsas on Dermatopathology and Lifelong Learning

In this episode of SEE HEAR FEEL, Dr. Rosalie Elenitsas from the University of Pennsylvania shares her extensive experience in dermatopathology. She discusses her career journey, the importance of daily consensus conferences, learning from junior colleagues, and managing work-life balance. Dr. Elenitsas also offers valuable advice on building a support system, continuous learning, dealing with errors, and the significance of simple yet effective practices in both professional and personal life.

00:00 Introduction and Guest Introduction

01:12 Personal Anecdote: Learning to Ride a Bike

02:08 Advice for a Successful Career

05:15 Work-Life Balance and Support Systems

08:52 Dealing with Errors and Continuous Improvement

13:08 Conclusion and Final Thoughts

Dr. Rosalie Elenitsas, MD is the Herman Beerman Professor of Dermatology and Pathology and the Director of the Penn Cutaneous Pathology Services since 1999 at the Perelman School of Medicine at the University of Pennsylvania. Dr. Elenitsas has been a faculty member at Penn since 1991 and has been director of the Dermatopathology Fellowship Program since 1998; she recently transferred the directorship to Emily Chu just this year. She has published more than 200 manuscripts/chapters, and has given more than 100 invited lectures. She is associate editor of Lever's Histopathology of the Skin and the past president of the Pennsylvania Academy of Dermatology and past president of the American Society of Dermatopathology (ASDP). She received the Nickel Award for teaching in Dermatopathology by the ASDP, and has also been elected to the Academy of Master Clinicians at Penn Medicine, a coveted honor for practicing physicians in the Penn health system. 

Transcript

Christine Ko: [00:00:00] Welcome back to SEE HEAR FEEL. Today, I'm very honored to be with Dr. Rosalie Elenitsas. Dr. Rosalie Elenitsas, MD, is the Herman Beerman Professor of Dermatology and Pathology and the Director of the Penn Cutaneous Pathology Services since 1999 at the Perelman School of Medicine at the University of Pennsylvania. Dr. Elenitsas has been a faculty member at Penn since 1991 and has been Director of the Dermatopathology Fellowship Program since 1998. She recently transferred the Directorship to Dr. Emily Chu just this year. She has published more than 200 manuscripts and chapters and has given more than 100 invited lectures. She is Associate Editor of Lever's Histopathology of the Skin and the past President of the Pennsylvania Academy of Dermatology. She is also past President of the American Society of Dermatopathology and received the Nickel Award for teaching in dermatopathology by that society and has also been elected to the Academy of [00:01:00] Master Clinicians at Penn Medicine, which is a coveted honor for practicing physicians in the entire Penn Health system.

Welcome to Rose.

Rose Elenitsas: Thank you, Christine. Thank you for having me.

Christine Ko: I'm so glad to do this with you. Could you first share a personal anecdote?

Rose Elenitsas: Sure. I'll tell you something that is not common knowledge. When I was a child, I never learned how to ride a bike. We lived on the top of this big hill, and my mother would never let us ride bikes. So, when I was about 50, my girls who were about eight at the time decided that I needed to learn how to ride a bike. They taught me how to ride a bike. I was a slow learner, took a lot of falls, but eventually could stay up on a bike. It reminds me that we learn a lot from younger people. I learn a lot from my children, and everyone here at my workplace, all my colleagues, and of course, the trainees, they're all younger than I am. [00:02:00] And I learn a lot from them. And it really is something that keeps me coming to work every day. 

Christine Ko: I love that story. That's really good advice. Related to that, do you have other advice that you wish you had known earlier?

Rose Elenitsas: The one thing that has evolved from when I had to take over as the sort of senior dermatopathologist, I realized that people would come to me every day showing me slides. And so now what we have is we have a daily conference. And I think you might have something similar, the daily consensus conference, where it's primarily used for quality assurance for melanomas, but it's also bring your cases, and we really encourage everybody to bring all their cases, even if they're simple: is it a seborrheic keratosis versus a squamous cell carcinoma? Those can be tough. And the senior dermatopathologists of our group, we bring those as well. And so I think that's also a good thing for the [00:03:00] trainees to see, that the senior people struggle with these pretty sort of simple problems. 

Christine Ko: Yes. I agree with what you said. It's a little different for me, because ever since I started at Yale, we have had a daily consensus conference which I loved and have loved and still love and have really learned a lot from it and never wanted to miss it. So initially, I was new, and I was trying to understand the whole culture of the place and everything, so I'm not sure that I could really do anything differently, but it does tie into your comment on what the senior people do. I think it really helps when that kind of, I suppose vulnerability, like you said, is modeled by senior people. Like here, it seems maybe a little bit silly, but I do think it's important to see what other people think. Is there some cancer hiding in here? I do think sometimes what seem like simple questions are actually pretty controversial when [00:04:00] you come down and sit around the scope with five to eight or nine people. 

Rose Elenitsas: Yes, I feel like we experience those daily. And I think you and I are both lucky that we have this process and we can have these open discussions with a number of faculty members. Just knowing from our trainees who are going out looking for jobs, there are still many places out there that don't have that luxury. 

Christine Ko: Yeah. 

Rose Elenitsas: And there are positions where you might be the only dermatopathologist, and you're on your own. So we are lucky in that sense. 

Christine Ko: Yes, absolutely. You've already given me great insight into a couple of different things. Daily conferences as well as learning from people that are "junior" to us, whether kids or trainees. Do you have other tips for having a successful career, whether it's in academia or whatever else someone might choose?

Rose Elenitsas: I always try to keep things very simple. And [00:05:00] so, my thoughts on a successful career are very simple. You work hard. You don't take shortcuts. And you do your part. You're part of the group, you're part of the system, you don't take advantage of other people.

The other big piece about career that everybody talks about is your support system. It really is different for everyone, but you have to have it. I'll just tell you what mine is, but it really is different depending on your scenario. When we had children, we didn't have any family in the local area. And so my husband and I just decided that my career was going to take precedent, and he was going to do a lot of the diaper changing. You do have to sit down and consciously create your support system. 

Christine Ko: Was that a hard conversation to get around to?

Rose Elenitsas: It was not difficult. We did have [00:06:00] 1 plan. We were going to have a good daycare place. But then, when it was time for child number one to go to daycare, they didn't have the opening. They thought they would, but they didn't. And all of a sudden you're faced with, okay, our plan didn't work. And, it was my husband who said, your job, you make more money. Sometimes that's what it comes down to. 

Christine Ko: Yeah. I think that it is also generous of one partner versus another, whatever the gender, to do that. I do think I grew up very much with a sort of patriarchal mindset, I'll admit. And it's more unusual, I suppose I would say it that way, in the culture that I grew up with, for the male partner to cede the way to his wife. 

Rose Elenitsas: And the same with the way I grew up. When I grew up, there weren't dads who took care of the kids. And, even when we made the decision, my girls [00:07:00] are 22 now, it was not common. 

Christine Ko: Yeah. 

Rose Elenitsas: Maybe a little more common now. 

Christine Ko: Yeah. I really like how you put that. I think that sometimes simple seems silly, but I do think simple is actually not silly, and it's really hard to sometimes come to a diagnosis, something very benign and common like seborrheic keratosis, in a certain case.

And it's also hard to have, for me, this type of conversation in the relationships that are important to me, and I guess get the support that I need or give the support that is needed. I think also related to the culture that I grew up in, which kind of does also go back to, you work hard, you do your part and don't complain. Probably these things are simpler than I make them out to be, in my own head. Related to the way you think and have a very simple organization, although I think it's very deep, actually, do you have any thoughts on work life balance?

Rose Elenitsas: Yeah, that's a hot topic. It's different for [00:08:00] everyone. You work it out on your own. I think you just have to think about what is important to you and what you don't like to do. Things you don't like to do, then you should outsource them. Cleaning your house. I outsourced that from the minute I had a house. Cleaning my house, doing the yard, pay someone else to do it. Other things, like I like to cook. So I've never really tried to outsource that. For me, it's something I can do with my family. I cook with my husband. I can cook with my children. And it gives me family time and at the same time produces food. Latest thing actually though is as I teach my husband and daughters, how to cook that now they're cooking more for me, which I'm enjoying.

Christine Ko: That's really cool. Another question is, how do you continuously improve? 

Rose Elenitsas: The best way to learn, at least in dermatopathology, [00:09:00] is we learn from our patients. 

Christine Ko: Yeah. 

Rose Elenitsas: And so when you get a tough case, I think it's really important to talk to people about it, talk to your colleagues about it, talk to the clinician, look into the literature. And then do follow up and really put your best efforts in on the tough cases, because you will learn a lot. As you look into the literature, you find papers. You're like, oh, I didn't know that. And I find that's the best way to continually learn. Putting the extra effort in those hard cases, nobody's going to pay you extra to do that, but it really is valuable learning. 

Christine Ko: Yeah, it goes back to, work hard and do your part. I think the hard cases are one thing because a lot of times I'll feel like, okay, I did my best, and maybe who knows what the true right answer is. Someone might disagree with me, but I favor this, it's an opinion. But sometimes there are cases where I make a true error. I make a mistake, and it's unintentional. Of [00:10:00] course, if I knew I was doing it, I wouldn't do it. So it's not like a hard case where I'm like this or this and I'm struggling. How do you deal with that? 

Rose Elenitsas: First of all, everybody makes errors, right? We're human. We shouldn't think that physicians are infallible, even though sometimes I think society expects that. But the truth is we can make mistakes. So, I think the first time you see you have an error, you panic, right? Yeah. Like you said, we're physicians. We don't want to make errors. We want to help patients. After the panic sets in, I think, first, you try to correct it. If you can, try to correct it. The next thing you have to do after you overcome this feeling of, I screwed up. You have to analyze it. Like, why did it happen? You definitely need the analytical part. And then once you do that, it's good to put processes in place to maybe help prevent errors. Not always possible but, maybe [00:11:00] it's a physician has too many slides to read, and they're going too fast. You have to reassess that. Is that they didn't feel comfortable showing cases? And we have things like consensus conference. So I think moving forward, you want to try to put processes in place to reduce the risk of error. 

Christine Ko: I like how you broke it down. I've never quite heard it like step by step like that. So it's like step one, there's emotion involved, often panic, or, I'm scared, like, what did I do? What's the effect on the patient? And I know that for me, that panic stage can make it seem like to the other person that either, maybe I don't care actually, because I withdraw a little bit, cause I'm trying to withdraw from the situation to a certain extent. There's this whole host of "negative" emotions that can come with, being approached or realizing yourself that you've made an error. 

Rose Elenitsas: Also it can affect your self confidence. 

Christine Ko: Yeah. 

Rose Elenitsas: You're like, do I really know what I'm doing? 

Christine Ko: Yeah. [00:12:00] Yeah. Yeah. And a, should I be doing what I'm doing? Yeah. So, the emotions, but then you move on to step two, it sounds like, where you analyze. And then very importantly, step three, where you try to make sure it doesn't happen again. Yeah. I like that. I like that very step by step, methodological way. I can give an example.

Early on, I remember I measured a melanoma incorrectly. I probably I did it on 20x, I think, rather than 10x. And I didn't catch at, even at the time, I would usually double check just visually. Does that make sense? But, somehow it went out, and it was wrong, and it was caught, pretty quickly. Luckily I think the patient was presented at melanoma conference, and so it had no impact on the patient, but I felt horrible. And so now I have three checks. So my process is I measure it, I double check it's on 10x, then I take it off. I measure it with a ruler and make [00:13:00] sure that makes sense. And then I check one more time when I just put in the staging. Does that make sense? So anyway, I love that. Do you have any final thoughts? 

Rose Elenitsas: I will just tell you that it's a pleasure talking to you, and I was thinking that you should be interviewed for something similar, but then I realized that in this discussion you offer so many of your thoughts that is really rewarding to hear a lot of your comments and experiences. 

Christine Ko: Oh, thank you. Thank you, Rose, for doing this. I really appreciate it. 

Rose Elenitsas: It was fun chatting with you.