A Medical Student Course Designed to Teach the Principles of Laboratory Medicine
Rachel Gordezky, MD
Purpose: Laboratory medicine is critical to patient care, providing physicians with information to prevent, diagnose, treat, and manage disease. However, a recent survey of 1,768 primary care physicians reported uncertainty about ordering tests in 14.7% and uncertainty in interpreting results in 8.3% of encounters requiring laboratory testing. Contributing factors may include the growing number of available tests, and inadequate medical student education in laboratory testing. To address this gap, we developed a required two-week Lab Medicine course for fourth year medical students.
Methods: We recruited nine pathologists, three clinicians, and one faculty development expert to create the course. The course director sent weekly emails and conducted monthly meetings with course faculty. Using the concept of “backward design”, we developed educational activities for the course. At the end of the course, students were surveyed about pre-course knowledge of laboratory medicine; perceptions about daily sessions, course faculty, and various aspects of the course (e.g., learning objectives, assignments); lessons learned and topics that should be part of the course; and course strengths and areas for improvement.
Results: The course covered the following topics: principles of laboratory medicine; evidence-based laboratory testing; molecular testing; cardiovascular disease testing; infectious disease testing; coagulation testing; transfusion medicine; and anatomic pathology. Team-based learning (TBL) and a team video project were the primary educational activities. In academic year 2014-2015, 179 students took the course. Ninety-five percent of students reported no more than an average amount of knowledge of laboratory medicine prior to starting the course, whereas 74% reported increased knowledge by at least an average amount after the course. Most students felt the course structure and assignments supported course objectives, and 76% rated the course “Good – to – Outstanding” overall. The most important lessons students learned from the course were 1) consult the pathologist/laboratorian for questions, and 2) apply evidence-based medicine to laboratory testing. Gaps in the course included interpretation of common tests (e.g., CBC, chemistry, LFTs), rheumatologic disease testing, and test costs.
Conclusion: Knowledge and skills in laboratory medicine are essential for all physicians. Our laboratory Medicine Course is an effective way to teach medical students about the discipline of laboratory medicine, its clinical relevance regardless of specialty, and the pathologist’s role as a patient care consultant. The course can be improved by further refinements in content, including cost-effective care. For the future we would like to develop an integrated laboratory medicine curriculum that spans the four years of medical school.
Flipped Classroom Outcomes in a New York Medical School
Pearl Myers, MD
The flipped classroom is a pedagogical model in which the typical lecture and homework elements of a course are reversed. The idea of a flipped classroom draws on such concepts as active learning, student engagement, hybrid course design, and course podcasting. In 2011 Touro College of Osteopathic Medicine NY Harlem campus (TouroCOM NY) deans decided to implement the flipped classroom model throughout the entire curriculum. Prior to this date, a few courses at TouroCOM NY (anatomy, physiology and pharmacology) tried out the flipped classroom model and found that it was well received by students. In addition, course scored improved. To ensure session attendance and compliance, classroom sessions were turned into an assessment tool. There was course podcasting however the weekly classroom session consisted of a graded audience response system rather than student engagement techniques like patient case study-based or team-based learning groups. When some questions were asked, the students were allowed to discuss amongst themselves before submitting answers electronically. There were also “lightning round” sessions where the students are asked questions and were not allowed to confer with each other before submitting answers. Each semester these graded sessions counted for 10% of the course grade.
To date, each succeeding year, since TouroCOM NY started in 2008, has had a higher board score average than the previous year. Preliminary assessments imply that this flipped classroom model, started in 2011, increased the increment that the board scores improved from years 2011-2014. To further support this assertion, we will compare the admission GPAs, overall GPAs, and COMLEX 1 scores from 2009-2014. Since pathology comprises a large part of the board exam, we will compare pathology course scores as well. Our data has and will be provided by TouroCOM NY office of institutional research.
Ethics in Pathology Undergraduate Medical Curriculum – A Pilot to Design a Module in Ethics
Mary Mathew, MD
Aim: The introduction of ethics in pathology undergraduate curriculum should be an integral part of medical training as the ethical dilemmas differ in comparison to their clinical counterparts. However, very few countries have incorporated this subject as part of pathology training.
Method: A pilot questionnaire based study on the need for Ethics and implementation in the curriculum was administered to 4 general pathologists and 2 oral pathologists.
Results: The results showed that all unanimously agreed that ethics should be incorporated into the pathology syllabus. The total number of hours to be devoted ranged between 2 – 4 hours. The specific topics included a) Informed consent b) Ethical issues in autopsy practice c) Legal and ethical issues in transfusion medicine d) Ethical and legal issues in the use of archival tissue and specimens. The method of teaching recommended were didactic lectures, Case based learning (CBL), debates and movies. An alternate and innovative method of teaching suggested was critiquing a histopathology/bone marrow report. The mode of assessment included assignments, short answers and few questions in viva voice. Based on these results, a module has been designed for incorporation of ethics into the curriculum.
Conclusions: The aim of medical training is to produce well faceted doctors equipped with adequate knowledge of the subject inclusive of the ethical and legal aspects. The undergraduate medical curriculum currently has no formal inclusion of ethics in pathology which is the need of the hour in discipline specific training.
The Pathologist and the Physician – A Traditional Indian Marriage of Sorts?
Mary Mathew, MD
This study explore the relationship between a pathologist and physician which is akin to a traditional Indian marriage wherin the bride takes a backseat. The pathologist in this union is the Indian bride who though strong and intelligent is the faceless yet significant better half. The clinician, on the other hand, is the Indian groom, all domineering but has a bleak future without the bride. The stars (horoscopes) have planned this fareful union where both are literally knotted (“thaali”) to each other. Divorce is not an option but perseverance and good communication ultimately pays. It is important to remember that this relationship is sealed till retirement/death do us part. As with all Indian marriages, a clever bride places the groom in the center of her universe with the beneficiary being the child (patient) in this bond.
Results: The relationship between a pathologist and physician may be tumultuous but can be successfully navigated with good communication skills, professionalism and reasonable intelligence.
Conclusion: In conclusion, pathologist and physicians are advised to take a leaf from the traditional Indian marriage to make their relationship successful and magical.
Model Learning in Basic Veterinary Pathology: Pathology Psychomotor Skills (PPMS)
Suzana Tkalcic, DVM, PhD
With global trends in medical practice and education that follows biomedical data information explosion, technological advances and the availability of resources, there is a need for new approaches in teaching practical medicine and pathology. Founded on very principles of evidence based medicine, pathology as a basic science can have a leading role in these efforts. Model learning initiatives and game-ology are novel trends and learning strategies that present medical and/or pathological concepts in a readily digestible and memorable format to
the millennium/X generation students. At the College of Veterinary Medicine, Western University of Health Sciences (WU-CVM), Veterinary Pathology is incorporated in the Veterinary Basic Sciences (VBS) Course and presented in a problem-based learning (PBL) format in the first two years of the curriculum.
Veterinary pathology in PBL is not a short term course, but rather a veterinary basic science well represented throughout 4 years of the curriculum (in pre-clinical/Phase I/and clinical phases/Phase II and III). PBL is a unique learning environment in veterinary education that presents a real challenge for a Pathology Content Expert. With comparative medicine/pathology approaches incorporated into teaching strategies, laboratory exercises need to follow and create a practical learning environment for systematic and logical presentation of the concepts and requirements present in one medicine. Pathology skills (prosections, tissue sampling, terminology, gross pathology
evaluations) are clinical competencies that are in our model implemented in a Clinical Skills Course through a simulated set of exercises (“PPMS: Pathology psychomotor skills”). PPMS is strategically placed at the end of the 1st semester of the PBL, to fit with the clinical case sequences, since students to that point have already met gross pathology and necropsies as a part of their case learning issues. This exercise is the first contact/introduction of the freshmen to the gross pathology techniques where we address the important concepts in pathology description, necropsy and diagnostic sampling techniques.
The goals of the PPMS are: a) to broaden student’s ability to practice and integrate basic practical approaches in pathology; b) discovering applications of pathology skills in clinical diagnosis (field necropsy, diagnostic pathology); c) Appreciate the role of pathology/necropsy in medicine (diagnosis and treatment).
The objectives include: 1. to practice tactile, visual, auditory, olfactory and motor skills and apply them to different pathology scenarios/tasks using models; 2. To enable students to perform animal necropsies and collect samples for further diagnostic procedures.
The exercises are designed around applicable models (play dough, plastic items, food items mimicking the real-life scenarios), selection of which is based on instructor’s personal diagnostic pathology experiences and presented in a way to practice sensory skills: tactile, visual, auditory, olfactory and motor skills; diagnostic sampling techniques; and some cognitive skills: match the findings with the correct diagnoses regarding smell, touch, color, and texture.
These educational practices are easily monitored by the classroom assessment techniques that also provide basis for the targeted improvements to meet student needs and enhance learning. We anticipate this new method can be easily accepted in veterinary and medical education worldwide.
Evolution of Teaching Methods for Pathology Training in Undergraduate Medical Curriculum: An Indian Kaleidoscopic View
Swati Sharma, MD
Purpose: The history of pathology shares common roots with all other medical specialties. Since time immemorial pathology has been the cornerstone in medical education regardless of nation, race, or medical school system. From the era when the cause of disease was associated with gods and heavenly bodies, we have progressed to organ based disease and anatomical pathology, with the future directed towards nanopathology. The modern day medical school curriculum is also evolving and emphasizing on adoption of newer methods of teaching pathology with the aim that the students would accomplish the desired learning objectives and gradually become positive and self directed learners.
Methods: Didactic lectures and practicals which included specimen and slide viewing were the sole pedagogy methods in India. Currently there is a progression from the era of chalk and board teaching to powerpoint presentations. In order to make Pathology learning interesting and motivating, newer methods of teaching are being introduced in our medical college without compromising the fundamentals of pathology. These novel methods include Objectively structured practical examination, Problem based learning, Seminars, Self directed learning with vertical and horizontal curricula integration and reduction in didactic lectures.
Results: The current teaching methods integrate basic science with clinical medicine and these are likely to shape the future for medical teaching as learning is enhanced more by quality, nature and relevance of teaching rather than by quantity.
Conclusion: Judicious and balanced use of newer methods along with the traditional teaching methods will definitely lead to enhancement in students’ understanding of Pathology. Pathology teachers have to be proactive in shaping the new curriculum with the aid of peer and student feedback for constant improvisation of the curriculum.