Careers in Pathology & Laboratory Medicine: Master Classes - An Interview with Dr. Blake Gilks

In this special bonus episode of the GOSH Podcast, we feature a Pathology Research Rounds session with Dr. Blake Gilks, Professor Emeritus in the Department of Pathology and Laboratory Medicine at the University of British Columbia and Regional Medical Director of Laboratories at Vancouver General Hospital.

Dr. Gilks reflects on a career defined by mentorship, curiosity, and collaboration — one that has shaped the practice and progress of gynecologic pathology in Canada and beyond. He shares insights from decades of clinical and research leadership, including his work refining the classification of ovarian, endometrial, and vulvar carcinomas, and his pivotal role in advancing opportunistic salpingectomy as a prevention strategy for ovarian cancer.

As a mentor, collaborator, and co-founder of OVCARE, BC’s gynecologic cancer research program, Dr. Gilks has inspired generations of pathologists and researchers to approach discovery with both scientific rigor and compassion.

🎧 Join us for a thoughtful conversation on mentorship, discovery, and the lasting impact of a career devoted to advancing women’s cancer research.

For more information on the Gynecologic Cancer Initiative, please visit https://gynecancerinitiative.ca/ or email us at info@gynecancerinitiative.ca

Where to learn more about us:
Twitter – @GCI_Cluster
Instagram – @gynecancerinitiative
Facebook – facebook.com/gynecancerinitiative
TikTok – @gci_gosh

Transcript

00:00:02 Intro 

Thanks for listening to the GOSH podcast—The Gynecologic Oncology Sharing Hub. We share real, evidence-based discussions on gynecologic cancers, featuring stories from patients, survivors, researchers, and clinicians. Our podcast is produced and recorded on traditional unceded territories of the Musqueam, Squamish, and Tsleil-Waututh Nations. It is produced by the Gynecologic Cancer Initiative, a BC-wide effort to advance research and care for gynecologic cancers.  

00:00:35 David 

Welcome to province-wide Pathology and Laboratory Medicine Rounds. Today we're doing something a little bit different. This is the first interview in what we hope will become a series called Careers in Pathology and Laboratory Medicine Masterclasses. A series of rounds with featured structured interviews with leaders in pathology and laboratory medicine. These are designed to introduce the subject to the audience and educate us about the subject's motivation and approach for leadership in academic pathology, and also their vision for the future of pathology and laboratory medicine in BC. We're going to ask some questions and some follow-up questions and then there's going to be lots of time at the end of this engagement for audience participation and for questions to come from online or from the room. So I think this is very timely. Last week, there was an inaugural lecture to celebrate the amazing career of mentorship teaching and diagnostics of Louis Wadsworth, who unfortunately can't participate in a session like this today. And so those who didn't know him won't be able to learn from his outstanding example. And so it's really important that we learn from the excellence around us, and there is a lot of excellence. Now, pathology and laboratory medicine is an extremely diverse specialty. The first couple of speakers we've lined up are from the academy. But we would love to hear suggestions as to how to improve this series and for people, particularly those working in the broader community, who could be excellent subjects for such an interview. So today, our first guest is Dr. Blake Gilkes. He's a professor emeritus of pathology and laboratory medicine at University of British Columbia. And my first day as a pathology resident in 1991 was Blake's first day as a staff pathologist. And it's been the privilege of my life, really, to have been able to work with him and learn from him ever since. He has a stunning array of academic and clinical accomplishments. He's received national and international recognition for his leadership in both gynecologic pathology quality assurance, and has an impactful record of mentorship. And I'm sure many of the people who are listening today have been mentored by him. It's fair to say that he's succeeded in everything except retirement, which he failed at. But we wanted to take advantage of him before he figured that out. So I want to thank you, Blake, for agreeing to be our guinea pig and starting this series off. And we're going to start by asking you about your childhood. Where did you grow up? 

00:03:24 Blake 

I grew up in Fredericton, New Brunswick, and go back every year. I feel strongly connected still with New Brunswick. 

00:03:33 David 

When you were a child, were you a leader? 

00:03:37 Blake 

No. I was profoundly introverted and still am, and have sort of backed into most leadership roles, I would say. 

00:03:48 David 

Are there any lessons from your childhood which you still find valuable today? 

00:03:52 Blake 

The importance of integrity. My father sold cars. And if you sell cars in a small town, you have to do it in a trustworthy kind of way because you count on repeat business. Everybody knew him. He would put his name and phone number on a little key chain he would hand out when he sold the car. All of them on the weekend of their car wouldn't start. And just seeing that example of being consistent, having a long-range view, I think, was important. 

00:04:32 David 

Great. So at what point in your education did you think about entering medical school? 

00:04:40 Blake 

When the physics degree wasn't going so well. I thought that it might be time to think about something different. So medicine was there. I applied. I thought, well, let's try it and see. Education was a fallback at that point. I'd worked in the health physics branch for the nuclear power plant. This is pre-Simpsons, but I was in that type of environment. So I had some interest, I guess, coming out of that. 

00:05:11 David 

I think that's the importance of being able to pivot probably underpins a lot of successful careers. Are there any other moments in your careers where you also kind of pivoted? 

00:05:24 Blake 

I was going to be a family doctor. That was always my focus. And when my girlfriend, now wife, did her PhD at UBC, it became clear that for her, it was going to be a large center, a major university, and that maybe family medicine is not something that would be the same in a urban setting as what I envisioned in a smaller community. So changed at that point, spoke to David Owen, and here I am, as they say. It was a very much less formal process in those days to join a pathology residency because he said something like, Well, you can't start this summer, but you can start in January, would that work? Yes, that would work. 

00:06:14 David 

Yes, I think that would be-- current residents would be quite envious of the simplicity of that process. I mean, did you get into medical school in your first shot? 

00:06:26 Blake 

Yes. 

00:06:26 David 

And that was in Dalhousie. 

00:06:29 Blake 

Dalhousie. 

00:06:31 David 

Great. So I think, Jen, you're going to ask some questions about medical school. 

00:06:38 Jen 

You know, as a resident, you were always interested in hearing people's journey to pathology, and we got a little bit of a glimpse of that just now. Did you work as a family physician before you started residency, or were you considering the residency there? 

00:06:54 Blake 

Yeah, I did. So in those days, you got a general license out of rotating internship. I did that at Royal Columbian because Susan was at UBC, and then we were Prince Rupert, Mission, Denver, practicing for a bit. But then transition back to the residency here in 1985, see what pathology would be like. 

00:07:23 Jen 

I think we were talking about a little bit of an experience with family medicine before your career in pathology. It sounds like you started a pathology program in Vancouver. And I was wondering, throughout your residency, what was the best advice you've received from your peers, from your mentors? 

00:07:47 Blake 

I think Andy Churg said that you should only do academics because you enjoy it. That was sound advice. A lot of good mentoring. It was a great residency experience. Ended up in gynae pathology because I saw Phil Clement as someone who really was a world leader and someone I thought I could learn a lot from before I moved on. I didn't envision ever ending up in Vancouver at that point. But yeah, fortunate to have great teachers during the residency. 

00:08:27 David 

So what made Phil an excellent mentor for you? 

00:08:32 Blake 

Phil is also a very introverted character. So seeing that he could be successful without being outgoing, without having those social gifts was kind of neat. From Nanaimo or from a smaller community and able to succeed on an international level was a great encouragement, and he himself was very generous with his time. When I went to talk to him after thinking that this is what I would like to do, he was very supportive and threw open his office and collection of slides and things. So it was great. And then he helped me get electives and yeah. 

00:09:24 Jen 

It sounds like your mentorship with Dr. Klement really kind of shaped your fellowship. Was there something that you were specifically looking for for your fellowship in gynae path and molecular path? 

00:09:40 Blake 

My fellowship was based on having a job in the same city as my wife. So Philadelphia is a large city, and that helped. And she was doing her postdoc. So she did her PhD with Mike Smith, and then she did her postdoc with Beatrice Mintz at the Cancer Research Center. And I applied for and got a fellowship there, but it was negotiated that we would end up where she wanted to go for that cycle. And by the end of my fellowship, I was the senior pathologist at the Cancer Center. So there's a comprehensive cancer center in northeastern Philadelphia. There were two Nobel laureates on the small campus, a nice culture of talking about science stuff and clinical research. It was a good environment, but it was for reasons that are other than the usual planning of academic career. 

00:10:46 Jen 

And, you know, for those of us residents who are thinking about fellowship now or will be thinking about fellowship in a few years, what do you think would be the most valuable aspect to look for in a fellowship? 

00:11:01 Blake 

Thurlbeck's advice was to enjoy it, because after fellowship, you'll end up doing a lot of more mundane things. So it's your time to have a period of intellectual freedom. And it certainly-- that was it. In terms of what people would want, I think it's so individual what folks are looking for. It'd be hard to say anything sensible. It would be overarching. 

00:11:34 David 

You've told us about some good advice you received. Is there any advice which you received which, upon reflection, you would view as spectacularly bad, and if residents are given the same advice, they should perhaps not heed? 

00:11:51 Blake 

Oh, yeah, I have had lots of good advice and perhaps more bad advice. And it's helpful to have the contrast, I think. So the idea that if you were the head of a unit in the hospital, you should actually be able to perform all of the functions within that unit was bad advice. The world is too complex for leaders to be competent across a broad range, you have to delegate. It just doesn't work. And once I learned to delegate, things went much better, whether it was in research or in hospital leadership roles. So that was maybe the best example of bad advice I had. 

00:12:40 Jen 

And so speaking of leadership roles, throughout your tenure at VGH Department of Pathology, you spearheaded many initiatives, including GPAC, CIQC, and leadership roles during the COVID response. And you mentioned that as a child, you were always an introverted person. And I was wondering, how did these leadership opportunities arise? 

00:13:03 Blake 

So. My first leadership role was at UBC Hospital, when the person who had that role was told that they were not going to have that role any longer, and I was the nearest person, so I agreed to do it. And then as a succession of bold moves on my part like that, that took me forward. The COVID one, I was at home on a Sunday afternoon, I got a call from Donna Wilson, And I foolishly answered. So yeah, it was not orchestrated in any careful, strategic way. 

00:13:49 Jen 

And throughout your training as a young resident or staff, did you expect to become a leader? It sounds like you just kind of stumbled upon it. 

00:13:58 Blake 

Nope. I think I knew that when you sign up for medicine, you’re agreeing not just to do the medical expert role diagnostically for us or whatever you have, these other responsibilities that you're taking on. And I knew that I would probably have to do my share, but I was dreading it. 

00:14:24 David 

When you took on these roles, did you ever feel the weight of imposter syndrome? And if you did, how did you deal with that? 

00:14:35 Blake 

I don't know that I ever felt full blown imposter syndrome because I knew that I shouldn't be doing these jobs. There had to be someone more competent to be doing them. So that was a relief. It was like not a fear of being found out. I just it was clear that they hadn't had a very good search process. 

00:15:02 David 

Beyond imposter syndrome. Stunning new territory. 

00:15:05 Blake 

Imposter syndrome suggests that they've made-- there's some mistake, that you actually are competent, but you don't think you are. I wasn't. It should have been clear to everybody. 

00:15:19 David 

I think we could move into a very circular space, because the fact you were asked to do more things would suggest that you were good at doing these roles. 

00:15:29 Blake 

You figure it out as you go along, for example. But I had very little useful advice on the leadership front. By the time I got to the UBC leadership training stuff, I'd figured out the stuff. But invariably, by having made the mistakes first, it was experiential learning. 

00:15:49 Jen 

And throughout your learning experience, how would you describe your leadership style now? 

00:15:55 Blake 

If I were to enter into a new process where I was expected to be a leader, I would make sure I understood what the role was, what the expectations were, and whether I had the authority to deliver on that mandate. Because I see situations where people are given a set of expectations, but they're kind of doomed. There's not someone supporting them or backing them up. They can’t do the things that they have to do as a leader to deliver. So if you think medical leadership, it's often about ensuring professionalism, that patient care activity is done, and the work is distributed in an equitable way. I mean, we expect everybody on staff to deliver on the medical expert front, and professionalism to meet standards. Beyond that, it's probably going to be more distributed, the other roles. Some people are better at certain things. But as a leader, OK, I'm responsible for making sure that the work gets done. Can I set the schedule? Is that an assurance? Are people going to be allowed to write their own job descriptions and get out of doing stuff because they don't feel like it? Knowing that you're going to have the ability to go into meetings and actually make decisions, which is necessary under some circumstances. Not very often. Usually groups can make good decisions. One of the joys of working in medicine is that people go into it because they want good things to happen for patients. It's not like we're in competition for payday loans or video gambling terminal placements. We have something that motivates us to want to help people. 

00:17:59 David 

One of the CANMED core competencies is mentorship. And this is something, I think, that you've excelled at. And we'd like to learn more about your experience as a mentor. But first of all, during your training, you said you benefited from some wonderful mentorship. And did you sort of mimic the approach to mentorship of any of your mentors? Or what did you take from your mentors in terms of how you mentor others? 

00:18:35 Blake 

Difficult question, because mentorship is, again, so specific for the individual. They have different needs. So the first thing is finding out what their needs are and how it can fit, okay, this is what we're doing today. How can that be relevant for you at your position? Anything from pre-med to residents in programs that are not pathology oriented or research programs. So it really starts with understanding what people are interested in, and what they need, and potentially can get out of a mentoring interaction. 

00:19:21 David 

OK. So you've mentored many of us. And do you find-- are there any generic approaches-- so you said that you personalize your mentorship approach based on the needs of the individual. But is there any generic advice you can provide beyond that personalization about things which tend not to work in mentoring people or approaches you find are particularly successful? 

00:19:53 Blake 

So as the personal and as the leadership answer, I suppose, here, personally, I think it's taking the time to personalize it, find out what that individuals interested in trying to bring it somewhere that they're interested in. From a leadership perspective, I think you insist that everybody be involved in mentoring, that we have created, I think, a culture where it's the expectation that everybody will interact with trainees regularly. And that's part of the expectation professionally and not letting down your guard on that, allowing people to say, oh, I'd rather not interact with residents this year or going forward and stuff. And making sure that everybody buys into the culture as part of the leadership role and mentoring being done effectively within a unit. 

00:20:50 David 

We're moving on to another one of the CANMED competencies. Being a communicator and collaborator is really important. And you've had many collaborations over the years, both as a leader, but also in research. What collaborations are you most proud of? And why do you think they work so well? 

00:21:15 Blake 

Complementarity, not people doing the same thing, but able to do different things. There has to be some shared vision. More often than not, things don't work. But you see a need-- so with Naveena, it was the idea that Okay, we know that the most common form of ovarian cancer arises in the fallopian tube. Do we just give up at that point? No, let's translate it into practice so that practice reflects science, the clinical practice of medicine, because it has implications independent of case diagnosis. And she was incredible at getting people on board, making them do things that perhaps they wouldn't have volunteered for. I stood in awe of that ability. So that was fun. 

00:22:08 David 

And you must have, over the years, had less successful collaborations. And can you tell us about why some of these other collaborations didn't work so that your junior colleagues and trainees can learn from that experience and know what to avoid? 

00:22:27 Blake 

Oh, sure. So I was at Mass General Hospital, a pile of cases sitting on someone's desk for five years. And I write them up. And it turned out that they were examples of the phenomenon of simultaneous tumors of vermiform appendix and ovary. And they collected a bit of dust, but when I looked through them, it became clear that they were actually just mets to the ovary based on a few things that we won't go into here. So I knew that the person that gave me the pile would not believe me because I'm not that convincing. So I went to a senior colleague, ran the story past him, Bob Scully, and he said, oh, that makes sense. And then we got the other person on the side. And at that point, I stopped being first author on the paper because it turned from something really boring that sat for five years to something that was kind of interesting. And that was a useful example of warning signs in collaborations. They have to be efficiently even and generous in terms of according credit for it to work. And if you don't see that, it's time to move on. 

00:23:59 David 

What research contributions are you most proud of? When we were at the WHO gynepathology book meeting, your name is all over that book. But are there particular contributions which you look at and say, well, I'm very glad I did that. And perhaps if you hadn't done it, it would have taken a long time for someone else to get to the same place. 

00:24:26 Blake 

I guess the subclassification of ovary, endometrium, and vulvar cancer as currently done reflects a huge contribution from Vancouver, taking our population-based data for 5 million people and showing that these are relevant classifications starting in 2014 with WHO with our ovarian cancer work, and then 2020 endometrial cancer and vulvar cancer more fully realized in the sixth edition, which is just coming out next year. So that's, I guess, the overarching thing. There's not any one thing that stands out for me. 

00:25:13 David 

Not adenomalignum because it has a nice name. 

00:25:15 Blake 

It's a lovely name. 

00:25:17 Jen 

And, you know, speaking of the classification of gynecological cancers, many of the research efforts done by our gyne and GI groups have brought many significant changes to the clinical management for patients. And as pathologists or pathology trainees, whether it's someone in a pure clinical setting in a satellite site or a clinician scientist, at a kind of academic center, what are some ways and opportunities we can seek out for advocating for our patients? 

00:25:49 Blake 

Yeah, if you end up in a different setting. So if I'd end up back as a pathologist in Fredericton, New Brunswick, which is not for me a good fit for family reasons, it would've been oriented towards trying to get, identifying the time to adopt new diagnostic strategies so that those patients in Fredericton benefit. And it's not a case of having a five or 10 year delay before they see it. But one of the advantages of being a place like UBC is you can participate in the type of work that is establishing what the new approaches diagnostically are. Probably works best if you stick to what you know best. I'm a pathologist. I'm not a data scientist. I'm not a geneticist. I can contribute in my sphere and not get underfoot for the people who are experts in other areas, but have, through good fortune, a team that works well together with good coverage of the different realms and do what I enjoy and what I have some expertise at. 

00:27:11 David 

You've been a prominent leader in our community for many years now, and in particular in your role during COVID. And there have been many efforts in the past to sort of centralize pathology and laboratory medicine or reorganize it. Some things have happened and some haven't. But what do you think the optimal framework for lab medicine in BC should be? 

00:27:33 Blake 

As near to the patient as possible with as rapid turnaround time as possible, taking into account cost effectiveness. 'Cause sometimes you cannot do it at every site in the province. Say we have 30 hospitals and you need one site for British Columbia. If we had a rational healthcare system for the nation, you might only need two sites in Canada, for example, but we don't. So each province has to figure stuff out for themselves. But for BC, a single overarching system that delivers locally would be, I think, ideal, all connected to one integrated lab information system. 

00:28:23 David 

What do you think the biggest challenge that our clinical laboratory medicine faces and also academic pathology? 

00:28:31 Blake 

Let's start with academic pathology. For academics, things will continue to change. Haven't touched the potential of AI in medicine. Critical look at whether there's value added and stuff that we do in medicine, taking into account some of the inherent conflicts of interest and maybe neutralizing those to provide better patient care. A lot of opportunities there to improve patient outcomes. Now, for the practice of pathology, yeah, it's just going to keep evolving, driven by technology. We're the ones that can ensure that the implementation is rational, I think, gain a tremendous opportunity. 

00:29:21 Jen 

Thank you for answering all of our questions. 

00:29:24 David 

So at this point, we're going to open up the floor for questions. And I think you can really ask Blake anything you'd like. Are there any questions in the room? 

00:29:36 Audience 

Thanks, Blake, for sharing all your experiences. And I think the thing that struck me the most is your reluctance, acceptance of leadership, and I would echo what David said, that I think you're underselling what you bring to the table for leadership, especially because I think that, you know, what you're seeing south of the border is people who go into leadership for the wrong reasons, for ego and self-interest, and I think you are the opposite. I think that you reluctantly went into leadership because you weren't interested in it from an ego standpoint, and I think that, you know, even just from some of your answers, you're clearly looking at from the good of the system or the patient and not yourself. And so I think that more than anything, I think you're a good example of someone who, even though you felt like from your introverted tendencies, you're not well-suited for leadership, I think that that's actually kind of almost the opposite. And I think in our profession of pathology, a lot of people don't really consider themselves potential leaders because of their more introverted natures, and I hope that they can use you as an example to maybe reconsider that. I don't know if you have any advice for people who might be struggling with that dilemma. 

00:31:03 Blake 

I guess I still would see myself as someone who was not a really ideal candidate for leadership that I think we've handicapped the leadership positions to such an extent that they're very unappealing. And we don't want that. We want to recruit the best and brightest and people who are gifted in the skills that help to be an effective leader and don't look at positions and think, oh, my gosh, that's doomed. So I quit in frustration from the ECH position because I didn't see a chance to succeed with things that needed to happen. I could point to things and say, look, there's nobody else in North America doing it this way. Don't you think we should change it? Nothing happens. I'm not persuasive enough or politically savvy enough to make them happen. I just gave up. But couldn't we just empower our leaders to lead, as opposed to say, you're responsible for all this, but if anything bad happens, pin it on you. We'll replace you. Try and do something. We are not going to support you and back you up. It was really a difficult thing to step into. And I hope that they realize that there is a need for leadership. It's one digression. I mean, David's made the point that errors of omission are much more acceptable than errors of commission. But there's a big cost to not doing things. You fall further and further off where you should be. Couldn't we decide to do something, make it happen, and get on to where we should be as a specialty and inpatient care, rather than wait for a crisis and then step up, which seems to be one of the strategies, sadly. So I would like it to be a situation where young people would think that that would be a good option. I should think about that or be more willing to take it on because they see a chance to say, you know, these are the things I would think I would like to do. What do you think? Would you support me in doing that if I become the leader? Never those types of discussions. It was always, you know, do this, but don't bother us. Take care of things. Don't stay out of the paper. 

00:33:42 Audience 

Well, I think you're also dealing with a large system that's resistant to change. And so maybe that's maybe part of the frustration you felt was that--  

00:33:58 Blake 

It's true. Big enterprise systems aren't very nimble, are they?  Sometimes more so than we imagine when we look south of the border. There's often a tendency not to do anything, but, and you have to, you have to, I mean, we can't continue to type out ECG reports on paper and send them out. We're all interconnected. We have to get on with that. How do you make that, how does that work rationally within Vancouver coastal? How does it work province-wide? Where are those discussions being held? 

00:34:29 Audience 

What would be the most difficult challenge in clinical work you encountered as a finishing resident junior staff and did you overcome it? 

00:34:38 Blake 

Guess the most difficult challenge I would relate to starting in leadership and Dennis Grant gave me very good advice said you must be completely fair and I mean you have to have difficult discussions with people and you can't put those off but you want it to be clear to everybody that you are working as hard as you can to be fair. They may not agree with you, but that it's motivated by that. And it gets easier as you go along in a leadership role, as you perhaps acquire a reputation for doing things with that type of motivation. But the first time, the first few months of having a role like that, and going into someone's office when you'd rather not go into their office and saying things that they would rather you weren't saying and probably you would rather you didn't have to say as well, but you have to do it. That's the job. And getting past that and being consistent and carrying forward, holding to that advice is probably the hardest thing. You have to look past personal things and make the right decision, and then change if there's new information, change and say you were wrong. 

00:36:05 Audience 

Thank you, Blake. There's one more question, and that is, you mentioned a more centralized pathology system as being more ideal. What do you think needs to happen to make this a reality? 

00:36:15 Blake 

Because we are not leaders in implementation of lab services in BC, we can look anywhere and see people that are doing things that would be an advance over what we're currently doing. So maybe just choosing some of those examples, what's happened, Cleveland Clinic, Henry Ford, Kaiser Permanente. So without getting into specifics, there's lots of things that could be done, except they would transcend health authority boundaries. And those boundaries are absolutely beyond the reach of anybody in our department to move past Budgets do not shift. So if there's a lab here and a lab across the street here, separate budgets, the budgets are separate to the very, very highest level. So it probably would take someone from the Ministry of Health to be involved to get some of these things going. I would see it, things could happen within your environment, but zero ability to engage, even find who you should talk to, to have things go across health authorities and being rebuffed when you would approach CEOs and say, look, I think this could be better for patients. 

00:37:42 David 

At this point, I'd like to thank Blake. Thank you so much for speaking to us today and sharing your experiences and your wisdom. 

00:37:52 Outro 

Thanks for joining us on the GOSH Podcast. To learn more about the Gynecologic Cancer Initiative and our podcast, make sure to check out our website at gynecancerinitiative.ca.