2018 Poster Abstracts

101 – The Effects of a Student Led Inter-professional Anatomy and Pathology Event
Jette Hooper and Maurice Fremont-Smith
Frank H. Netter MD School of Medicine at Quinnipiac University

Purpose: To determine if a novel, student-led, anatomy-pathology teaching session using student-created cadaver frozen sections assists medical students in understanding year one histology and physiology and the importance of these subjects to their future careers.

Methods: During the 2016-2017 academic year there was an anatomy-pathology inter-professional event that involved Frank H. Netter MD School of Medicine students and Quinnipiac University Pathology Assistant students. In this event a pathologist worked with medical student anatomy groups to identify pathology on their donors and then assisted the Pathology Assistant students in the creation of frozen section slides. These slides were subsequently taught to other medical students by the student creators in a medium group setting. There were 88 year one Frank H. Netter MD. School of Medicine students from the class of 2020 who participated in the event. All of these students were emailed an anonymous Survey Monkey survey to their school email addresses. Students were required to read a digital informed consent. If they clicked “continue” it was deemed they consented and then progressed to the survey. The survey included 8 multiple choice questions and one free response text box pertaining to the event. Students were given two weeks to respond.

Results: All 88 students from the Frank. H Netter MD School of Medicine class of 2020 were included in the recruitment email, no students were excluded. There were 45 responses. Students responded that the perceived effect of the event on their learning of normal physiology and histology was a strong positive for 10, weak positive for 28, and it did not affect 7 people. There were 30 students who reported that the event positively affected their perception of the importance of histology and physiology to their career as a physician. Of those 13 students reported a strong positive affect, while 17 reported a weak positive affect. There were 14 students who saw no effect and one student who reported a weak negative affect. In response to the effect of the event on students perceived learning of abnormal pathophysiology, 15 students reported a strong positive effect, 22 a weak positive, and 8 that it did not affect. Additionally 35 students recommended continuing this event for future classes, 7 were neutral, and 3 did not recommend it. Lastly working with the pathology assistant students had a strong positive effect on 26 students, a weak positive effect on 6 students, did not affect 12 students, and weakly negatively affected 1 student’s learning experience.

Conclusions: This integrated classroom event positively affected student’s perception of the importance of histology and physiology to their careers as physicians. This event also positively affected students perceived understanding of histology and physiology. Additionally the majority of students thought this event was beneficial enough to recommend continuing. Our school will be continuing this event for future classes for the effect on students perceptions about physiology and histology and for the unique opportunity for collaboration between medical students and pathology assistant students.

102 – How to become an Innovative Pathology Educator
Shirley Siew
Michigan State University

Becoming an Innovative Pathology Educator implies that the Pathology Education must come directly from the Educator and not from assigned learning material in a text book, not from an on line program nor prerecorded lectures. Direct transmission of education can be achieved by a well presented lecture, which has stood the test of time and, which is the best means of getting the greatest amount of information in the shortest amount of time to the largest number of people, at the same level. The last two factors are of particular importance at the present time, with the gross increase in the size of the classes However, the ideal method of teaching Pathology is at the Autopsy, with the presentation of the Pathology, with lesions  in the “fresh” state-not after having been fixed in formalin and the obvious clinico-pathologic correlation. A drawback is that Autopsy cases do not come in a logical learning sequence, with advanced pathology cases preceding those that demonstrate simple lesions. But, the major problem is the drastic decrease in the number of autopsies, and, once again, the gross increase in the size of the classes. So, Autopsy tuition is not a practical means of Pathology Education at the present time.

One can become an Innovative Pathology Educator by constructing an Innovative method of transmitting the Education to the students. Once again, the increased size of the classes has led to diminution in Practical Pathology Laboratory experience. Pathology is a Practical subject and cannot be learned properly out of textbooks, nor atlases. The construction of innovative Practical Pathology education involves an interactive involvement of the students with the instructor, not a one-way transmission of information from the Educator. The students will be required to work their way through the Clinical History, the Gross and Microscopic Pathology and arrive at the Clinico Pathologic Correlation.

103 – Peers as Laboratory Teaching Assistants in Medical Histology
John R. Cotter, Jeffrey Aldinger, Max Blumberg, Joel Braverman, Peter Fields, Alexander Loftus, Jacob Welch, Robin Wilson, and Adrian Ziaggi
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo

Purpose: To facilitate the interactions that should take place between instructors and learners in the setting of a microscope laboratory

Methods: In the first year of implementation, six peer teaching assistants (PTAs) were selected from a class of second year medical students to assist faculty assigned to five laboratory sections. Criteria for participation included a demonstrated enthusiasm for the subject and a desire to assist their peers. The following year less attention was given to student attitudes and behavior and more attention was given to exceptional performance by first year students in a foundation module that was focused on cells and tissues.

The PTAs met individually with a member of the faculty or in groups of four at a conference microscope before several organ system module laboratories to discuss the objectives of the laboratory exercises and review the microscopic slides used in the modules. The PTAs were instructed on the capriciousness of some of the specimens and provided insights into the types of questions they should anticipate being asked.

Results: A) PTAs – The PTAs were comfortable as peer instructors and relished engaging fellow students. There was a noticeable reluctance to participate between first and second year students however; and many first year students who were invited to participate chose not to do so. The inability to attract PTAs from the first year class may be due to the insecurity of being new to the medical school and/or the stress of performing well in first semester courses including gross anatomy. B) Learners – Initially, learners, especially those in the first year class, were reluctant to ask questions. We could only hypothesize why this might be: resentment at having to ask a peer for help or unwillingness to accept the PTAs as content experts are possibilities. C) Questionnaire – Thirty-five percent (50/146) of the second year students (class of 2019) responded to a web based survey with the following results: 1) the presence of PTAs very much (31.37%) or somewhat (21.57%) helped students learn the material. 33.33% of the respondents did not believe that was the case; and 13.7% had no opinion. 2) 68.63% felt that two instructors/laboratory was sufficient. 15.69% did not feel there were enough instructors and 15.69% did not find that they needed help. 3) 68.63% thought the program should be continued. 31.37% did not think it was worth the effort. 4) 45.10% thought the program should be expanded to the first year; 21.57% did not think it was beneficial; 19.61% did not think it was necessary to add more instructors; and 9.80% had no opinion.

Conclusions: The use of PTAs helped overcome difficulties that arise due to an inadequate number of instructors. Half of the learners who responded to a questionnaire agreed the PTAs helped them identify the structures they were asked to find on histological specimens. Although the results of the survey were mixed, the success of PTAs with learners who experience difficulty suggest that PTAs are a worthwhile strategy to boost learning in the microscope laboratory.

104 – Comparison of Methods Designed to Improve the Podiatric Student Learning of Critical Thinking Skills Applied to Patient Encounters
Mary A. Mooney, Joann Petty Eble, and Edweana M. Robinson
Kent State University College of Podiatric Medicine

Purpose: Students starting their medical education generally need practice to effectively interact with patients. This study compared the effectiveness of computer-based programs and the current Socratic method in preparing a participant to more effectively perform a simulated patient work-up.

Methods: Thirty-one students were enrolled into the study and randomly assigned to one of three groups: 1) control, 2) presentation-based, or 3) avatar. The GPA’s for each group were normalized to minimize differences in the groups. Participants in all three groups underwent an initial simulated patient exercise, scored by a co-investigator and the simulated patient “actor” who evaluated communication skills. All students received the three computerized case studies in the second year curriculum. The control group had no additional exercises until the final simulated patient exercise. The presentation-based group completed an extra four computerized cases, while the avatar group completed an extra four computerized cases using a program with a patient avatar. At the end of the study, all three groups had a final simulated patient case evaluated by the co-investigator and the simulated patient”actor”.

Results: Students in all three groups exhibited an improved ability to perform a simulated patient examination. In fact, with a confidence level >99% there was an increase in each group separately. On a five point scale the pooled data shows the average initial score of 2.40 increased to 3.09 on the final case. An initial analysis of the difference in mean increase between the three groups shows no statistical difference in the increase in scores; however both the presentation-based and avatar groups scored better than the control group.

Conclusions: It was demonstrated that students’ ability to perform a simulated patient exercise increases with practice. Groups exposed to an increased number of computerized or avatar cases performed better than the control group, although the improvement was not statistically significant. There may be other reasons to choose one style of computer patient program over another, such as ease of use, ability to access a large bank of cases, and ease of scoring the exercise.

105 – Pathology Boot Camp: A Focused Training Program for Medical Students that Aids in the Transition to Pathology Residency
Brannan Griffin, Kruti P. Maniar, Kristy Wolniak, and Luis Z. Blanco, Jr.
Department of Pathology, Feinberg School of Medicine – Northwestern University

Purpose: Pathology residency requires specific knowledge and unique procedural skills that graduating medical students have limited exposure to and/or lack when entering residency. However, most programs rapidly assign clinical responsibilities to incoming residents despite their deficiencies. The Pathology Boot Camp was thus designed as a focused training program with introduction of basic skills and processes that are essential for performing expected duties. The ultimate purpose was to increase the students’ confidence and to impart a better sense of preparedness to begin training in Pathology residency.

Methods: Select topics that would best aid medical students going into Pathology were obtained by polling a group of faculty, fellows, and residents. Topics were reviewed and prioritized in order to create a program that could feasibly be implemented during the pre-determined, limited three day period.  Topics covered included: safety and personal protective equipment, specimen processing in histology and immunohistochemistry, basic gross examination techniques and report dictation, frozen section evaluation, basics of the microscope, review of basic normal histology, introduction to autopsy, blood bank basics, introduction to hematopathology, and common clinical pathology call issues.  The topics were discussed in lectures, as well as in hands-on practical sessions with instructors.  Last, a one hour open forum session at the end of the boot camp was held to give the students an opportunity to discuss any concerns and to get answers from faculty, fellows, and residents.

Results: Fourth year medical students going into Pathology for the year 2017 (n=3) attended the Pathology Boot Camp over the three day period and received the focused training program.  Feedback from all of the students was positive. Students reported increased awareness of expectations and basic skills helpful for Pathology. Students also reported decreased anxiety regarding beginning residency.

Conclusions: Given that dedicated lectures and practical laboratory sessions are decreasing and becoming more fragmented during medical school, students who choose a career in Pathology not only have less exposure to topics fundamental to the practice of the specialty but also may not even acquire the basic skills vital for successful transition into residency (i.e. using a microscope). This circumstance both produces students lacking crucial proficiencies and leads to personal anxiety about beginning Pathology residency.  With the development and implementation of the Pathology Boot Camp, we were able to provide a focused training program to address some of the issues and deficiencies that helped our students to be more confident and feel more prepared for their transition into Pathology residency.

106 – A Cutting Edge Mixed Method Approach to Educate Millennials in the era of Personalized Medicine
Ritcha Saxena, Nga Min En, Ananya Saxena, and Ritwik Raj
Department of Pathology, ASU School of Medicine, Dominica, Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, and Department of Biomedical Engineering, Delhi Technological University, India

Purpose: The mind is not a vessel that needs filling, but wood that needs igniting- Plutarch.

And for that, it needs the right educational strategy – that, which not only creates a passion, but also develops critical thinking. Conventional didactic lectures alone cannot fulfill this goal. A mixed method approach that melds interactive classroom teaching with team-based and active learning strategies helps in realizing this objective. In the era of personalized medicine, it is essential that pathology educators focus on training the students in multi-omic studies integrated with virtual gross & microscopy and clinical case studies, to provide a comprehensive understanding of the disease process and a smooth transition to clinical sciences.

We propose an innovative mixed method approach that aims at enhancing problem-solving skills, critical thinking and self-directed learning abilities to make sure our students have an absolute understanding of the core concepts in genomics along with pathophysiology, morphology and histopathology, and their ability to apply them in the clinical setting.

Methods: We introduced a genetic curriculum integrated with selected general and systemic pathology topics. In the interactive large group lectures, virtual museum, virtual microscopy and virtual IHC were discussed together with relevant genomics and clinical case vignettes.

41 students of undergraduate semester 3 and 59 students of undergraduate semester 4 participated in the TBL exercise. The TBL sessions were organized in small groups of 5-6 students each.  The students were provided with relevant multi-omics-based case studies in the form of articles from journals, presentations and papers, as part of the TBL exercise. Pertinent genomics animations, IHC and microscopy were also provided as per need. Students were then cross-examined by instructors. The students’ reaction to TBL was assessed using a combination of closed and open-ended questions. Students were tested individually before beginning the TBL exercises and then after TBL exercises, and the results were compared periodically.

Results: The students’ reaction to TBL was encouraging, with 95 per cent students giving a positive feedback. Evaluation through readiness assurance tests (IRAT and TRAT) in the form of MCQs indicated that the students not only had a solid grasp of the fundamentals, but also a better ability to apply them to the clinical picture. Introduction of journal-based case and research papers amplified the interest of students in research work.

Conclusion: Fundamentally, modern medical science is combinative by nature, and, to educate millennials at the interface of basic sciences and clinical medicine, novel approaches should be introduced to produce competent and efficient physicians. Introduction of a multi-omic approach with TBL exercises and interactive didactic lectures proved vital in developing a learner-oriented mixed-method unified educational strategy that turned out to be an excellent way to aid students with better retention of key pathological concepts and their application in the clinical settings, along with appreciation of the importance of teamwork from the very beginning.

107 – Failure to Learn versus Failure to Retain: Histology and Pathology Alignment
Kimberly C. Redding and Aleeia L. Johnson
Morehouse School of Medicine

Purpose: Morehouse School of Medicine (MSM) was established in 1975 as a “minority-serving institution educating doctors who would practice in underserved communities”. MSM recruits an academically diverse and successful student body by using a holistic approach focusing on academic performance and character traits indicative of an individual capable of becoming the type of physician that promotes the institution’s mission.

The first-year medical school curriculum is horizontally integrated such that lectures and laboratory sessions are delivered in foundational topics and organ systems concurrently by the traditional disciplines of Human Morphology (Cell Biology, Histology, Anatomy, & Embryology), Biochemistry, and Physiology via three sequential courses (Basic Principles, Organ Systems 1, and Organ Systems 2). The same traditional disciplines, related to Neurobiology, are delivered in Organ Systems 3.  The second-year curriculum includes separate, concurrent courses of Pathology, Pathophysiology, Microbiology, and Pharmacology & Toxicology.

Faculty members continually monitor and evaluate student performance in each course via formal and informal means. Recent evaluations revealed a knowledge deficit in prerequisite information, required for optimal performance in the second-year pathology course. We suspected that this knowledge deficit was the result of lack of retention between the first and second years of medical school. We sought to evaluate the retention of key histology concepts, deemed necessary for success in pathology, from year one to year two.

Methods: To test the students’ retention of concepts delivered during the first-year, we began by compiling all histology questions included on each of the examinations administered during the first-year for the cohort of students currently in the second-year. Two pathology faculty independently reviewed questions with the intention of choosing questions that (1) tested retention of concepts taught in histology lectures and laboratory sessions (2) addressed concepts that provide students with readiness for pathology, (3) would serve as a baseline for comparing student performance on future assessments.  A total of 171 questions were reviewed. Twenty-five questions, covering nine organ systems and several foundational topics, were selected. The questions required varying levels of cognitive tasks from simple recall to case study analyses. The assessment was administered over 30 minutes via the institution’s electronic exam portal.

Results: Ninety-two (92) students completed the assessment. The average performance on the assessment was 66.09% (16.52/25). By comparison, the average performance on the same questions administered during the previous academic year was 87.74% (21/25, n=101 students).  The average change in score for students having both sets of data available for comparison was -23%/-5.46 points (n=89 students).

Conclusion: We demonstrated that the student cohort displayed a 23% decrease in retention of information that was determined to be foundational for understanding the material presented in the year two pathology course. This decrease in retention confirmed previous suspicions raised by previous students’ overall performance in the pathology course, and during pathology laboratory sessions.  Based on these findings there is a need to ameliorate the loss in information retention between the first and second years of the medical school curriculum.  Additional data is being collected. An intervention will be developed to address this issue.

108 – Lessons from Wall Street: Implementing a high-stress environment resiliency strategy into a medical residency program
Marisa Saint Martin
Loyola University Health Systems Robert Paul Sweeney, Business Process Consultant

Purpose: The National Institute for Occupational Safety and Health (NIOSH) places physicians in the highest risk profession for suicide, at 1.8x the national average, followed by employees in the Financial Services sector at 1.5x. These segments experience similar needs in managing job related stress to ensure employee health and job performance. Goldman Sachs has implemented a program which goes beyond stress management and promotes employee resilience. While stress management in the medical workplace is addressed in various ways, it is often limited to stress reduction through initiatives and techniques predominantly targeting burnout. Few residency programs offer formalized resilience training. The purpose of this study is to analyze the various initiatives Goldman Sachs utilizes to increase resilience, the effectiveness of these programs, how results are measured, and determine how this may be applied to a medical residency program.

Methods: Goldman Sachs’ resiliency program includes lectures, individualized coaching, quarterly resiliency training, and a bi-annual “Resiliency Week”. Their approach is focusing on stress prevention, treatment, and determining how to keep employees competitive and performing at their best while maintaining wellness and increasing overall happiness. At Loyola, we approach the dilemma of burnout with a tri-dimensional strategy: initiatives for the individual, the group, and the institution. An initial survey of pathology residents indicated an overall need for a formal wellness/resiliency curriculum. Currently, residents have access to free sessions with trained resilience coaches, psychological help as needed, and the EAP. Additionally, we have implemented a mentorship program within the department, taught a 30 second mindfulness technique, and have reduced cost fitness facilities on site. Volunteer and inter-departmental networking are also available. A brief survey to identify one positive, one frustration, and one thing that needs to be changed has given us a framework for departmental improvements and initiatives that we can forward to the administration to be possibly applied at the institutional level.

Results: Methods are being developed to tangibly measure the results of the resiliency program in our department, along with cost/benefit analyses to determine the appropriate level of institutional funding for these programs. Our institution mission statement is a Quadruple Aim statement that includes not just Quality, Cost, and Patient Care, but also the well-being of the staff. In addition to initiatives following the tri-dimensional approach (in Methods), the Maslach Burnout Inventory survey will be extended to residents in 2017, providing a better measurement of burnout.

Conclusions: 92 % of Residency Program Directors surveyed in 2014 estimated that more than 50 % of residents are burnt-out. Though Pathology Programs are not generally considered a high burnout specialty, the 2016 Maslach Burnout Inventory survey put our department at the same level of burnout of our clinical colleagues. Like at Goldman Sachs, we are approaching this dilemma with a comprehensive strategy that will eliminate the stigma put on doctors suffering from burnout, providing residents with tools to maintain joy, humanity, and satisfaction of practicing medicine throughout their careers.

109 – “Tumor Board” Simulation: A Team Based Learning Activity for Third-year Medical Students Incorporating Basic Science and Clinical Knowledge
Brannan Griffin and Kristy Wolniak
Department of Pathology, Feinberg School of Medicine – Northwestern University

Purpose:  Medical school curriculum has traditionally been a four-year period divided into basic science courses predominantly in lecture and lab formats followed by clinical rotations with a focus on patient management. As the medical field continues to expand, this curriculum has evolved over the years through advances in optimizing education. Recent trends include incorporation of peer-to-peer instruction and emphasis of basic science material in the clinical years. Aptly, the Team Based Learning (TBL) “Tumor Board” simulation was designed to integrate and reinforce pathology knowledge in the clerkship years, as well as to introduce medical students to the importance of a clinicopathologic approach to cancer therapy. The 2-hour session was presented as part of an Interdisciplinary Curriculum Phase 2 (IC2) session attended by all third-year medical students. The ultimate goal of the session was to create an active learning environment engaging students through peer-to-peer instruction, question assessment, and correlation of multiple aspects of patient care.

Methods:  The TBL Tumor Board was conducted in a large group setting and covered 2 clinical cases over a span of 2 hours. A total of 105 third-year medical students were divided into teams of approximately 10 students each. All students were given brief pre-reading materials relating to each case (diffuse large B cell lymphoma and gastric adenocarcinoma). During the session, each case was presented in Nearpod format and included relevant patient data, additional clinical and pathology-centered educational materials, and both individual and group live questions or tasks. The session utilized interactive technology and allowed students to type their answers and circle/label histology and pathology images. During the TBL Tumor Board, Pathology and Oncology residents and fellows were available to assist with questions and facilitate discussion. The students’ answers were collected and scored.

Results:  The students were engaged and participated actively. Immediate review of student answers during the session allowed the instructors to gauge and respond to the knowledge strengths and weaknesses in a dynamic manner.  Feedback regarding the TBL Tumor Board was mostly positive (overall 4/5). Of those who responded to a survey, 73/105 (70%) agreed the TBL Tumor Board was an effective learning experience; while 13/105 (12%) disagreed and 19/105 (18%) were neutral. Praise was given for the session’s organization, engaging format, use of technology, and educational content. Suggestions for improvement included decreasing the activity’s overall length of time and time allotted per question or task, as well as covering more cases or topics within the time period.

Conclusions:  Medical school curriculum continues to evolve in order to adapt to the exponential growth of medical knowledge. A current movement in medical education is incorporation of peer-to-peer interaction and inclusion of basic science material within clinical instruction. Through our TBL Tumor Board simulation, we were able to design an educational activity for third-year medical students that integrated pathology knowledge with clinical information and engaged students in group-based learning. We were also able to introduce medical students in their clerkship years to the relevance of a clinicopathologic approach to cancer patient management.

111 – Comparative Pathology and One Health: Where Do We Fit?
Suzana Tkalcic
Western University of Health Sciences

Purpose: The One Health concept represents a paradigm shift in the western medicine and public health of 21st century that promotes an interdisciplinary and interprofessional approach to health and health-care on a global scale. It encompasses a holistic approach, effective communication, resource exchange and inclusive collaborations of all stakeholders involved in human health: human medicine, veterinary medicine and environmental health. Although that concepts is not foreign to veterinarians and pathologists around the world, it is gaining a significant momentum in the human medicine. As such, it present a challenge to the pathology education in general: the need to shift this topic from the postgraduate education to the medical education and where to incorporate this within the existing curricula.

Methods: There are 2 ways we propose to promote and incorporate this concept early in medical education: A) through interprofessional education (IPE) in a small group setting; B) through a comparative pathology approach in pathology. In this aspect, comparative pathology should focus on current issues and trends in pathology, virology, epidemiology, immunology, forensic science and through that interdisciplinary approach get incorporated into the curriculum. In that interdisciplinary approach we can be creative and include student-centered participation: student PPT presentations on a selected topic, invited lectures, model learning or lab exercises.

Conclusions: With known or new health challenges in the modern world, including emerging and re-emerging infections, zoonotic diseases, human-animal bond, intensive animal farming, toxic pollutants, translational research, and biomedical advances in molecular diagnostics, One Health and its comparative medicine stream is a logical paradigm shift to allow for effective and timely medical interventions to the presenting or predictive problems through the surveillance, biomedical research and capacity building worldwide in the diagnostics, treatment , and preventative arena. Comparative pathology incorporated in the existing pathology curriculum has an opportunity to provide a platform for students to build on, especially in the general pathology domain and through and carefully planned and facilitated interdisciplinary approach and interprofessional education.

112 – Histology Across The Human Lifespan – Endocrine System
James Dang, Nikhil Nadler, Andrew Ford, and Dana Peterson
Northeast Ohio Medical University

Purpose: Histology Across The Human Lifespan is a novel, educational project that provides innovative perspectives for students learning microanatomy (histology). Traditional histology textbooks/atlases will often only provide a few images of exemplar tissues, which may be of varying species, ages, genders, and sizes. This project, instead, presents human tissue images from both sexes in a chronological order, illustrating histological changes that occur throughout the lifespan as a result of various physiological processes. With the growing obesity epidemic, it is highly relevant to also investigate histological changes in tissues of obese individuals of varying ages. The goal of the Histology Across The Human Lifespan project is to provide a more comprehensive structure for teaching and learning microanatomy.

Methods: Tissue samples of Thyroid, Pancreas, Ovary, and Adrenal Gland used to produce the atlas’ images came from autopsies performed between 2000-2015 at three Northeast Ohio hospitals.  A hematoxylin and eosin staining protocol was employed to all tissue specimens prior to imaging.  The imaging was done using an Olympus VSI20 virtual slide microscope at 40x magnification.  The imaged slides were then analyzed for endocrine epithelial cell density counts (cells/mm2).  These analyses were performed for the following age categories: premature/neonate (0 – 6 months), infant (6 months -2 years), teenager (13-19 years), older adult (51-70 years) and elderly adult (71+ years).

Results: Pancreatic cell density appears to gradually increase and then decrease across the human lifespan, which seems to create a different trend from the other endocrine organs investigated so far. The cell density of the adrenal gland epithelial cells appears to just gradually decrease over time. Thyrocyte density appears to increase and peak during teenage years before declining across the rest of the lifespan. The ovarian stromal cell density trend shows a sharp decrease that occurs shortly after birth; the density remains relatively consistent after infancy. Finally, tissues of obese individuals generally had a reduced cell density.

Conclusions: While this work has added breadth to the amount of organs covered by Histology Across the Lifespan, there is still much more that can be done. Future work will complete the atlas’s coverage of the endocrine system while also commencing the process for the other organ systems. Furthermore, the foundation has been laid for more in-depth analyses that will help quantify various histological aspects of aging.

113 – The pathology mini-elective: a unique educational opportunity to introduce early stage medical students to the discipline and practice of anatomic and clinical pathology
Marie C. DeFrances. Simion Chiosea, Sara E. Monaco, Larry Nichols, Karen Schoedel, Karl E. Williams, John F. Mahoney, and Trevor A. Macpherson
Department of Pathology, University of Pittsburgh School of Medicine, Department of Pathology, Mercer University, Allegheny County Medical Examiner’s Office, and Office of Medical Education, University of Pittsburgh School of Medicine

PURPOSE: In 2006, the University of Pittsburgh School of Medicine (UPSOM) introduced ‘mini-elective’ courses as a means of enriching undergraduate medical education for first and second year medical students.   Mini-electives are extra-curricular, non-credit, ungraded activities offered one afternoon per week for up to eight weeks each spring.  They are designed to provide a limited number of interested students with in-depth exposure to medical topics or to allow students to actively explore aspects of medicine not encountered in the pre-clinical curriculum.   Pathology is taught at UPSOM as a 2.5 week introductory course during the first year basic science core.  Organ-specific pathology is integrated into the organ systems courses which begin late in the first year and extend through the second year.  To expand upon students’ finite exposure to the field of pathology in the pre-clinical curriculum, UPSOM pathology faculty have utilized the mini-elective format to showcase specific areas of pathology practice.  Since 2008, six different pathology-centric mini-electives have been offered on topics that include the following:

  • Introduction to Clinical Pathology
  • Behind the Veil of CSI: The Real World of Forensic Medicine
  • Introduction to Anatomic Pathology
  • Mini-Biopsy: Making Diagnoses with Fine Needle Biopsies with Radiological Correlation
  • Multi-Disciplinary Approach to the Diagnosis of Musculoskeletal Neoplasms
  • Personalized Medicine: The Impact of Molecular Testing on Patient Care

METHODS:  Electronic evaluations utilizing a 5-point scale were sent to student participants at the conclusion of the pathology mini-elective. Anonymized evaluation data from 2008 – 2017 were reviewed.

RESULTS:  From 2008 – 2017, over 30 instructors and 100 students participated in pathology mini-electives.  The average’overall quality score’ of the pathology mini-electives was 4.6 (of 5.0).  Students’ comments describing the mini-electives were favorable.  However, no significant difference in the average number of UPSOM medical students choosing pathology as a career was noted after implementation of the pathology mini-electives.  From 2000 – 2009, an average of 2.1 ± 1.3 (range 0 – 5) UPSOM medical students matched in a pathology residency program compared to an average of 2.5 ± 1.5 (range 0 – 6) UPSOM medical students from 2010 – 2017.

CONCLUSIONS:  The pathology mini-elective format provides medical students in the early stages of training with a unique opportunity to actively engage with pathologists which may increase their familiarity with the discipline of laboratory medicine and enhance their comfort level to interact and communicate with pathologists in the future.  Although the average number of UPSOM medical students choosing pathology as a career did not increase after implementation of mini-electives, these brief educational courses in pathology are well-received by students.

114 – Ultrasound-Pathology Correlations in Medical Education
James F. Catroppo
University of South Carolina School of Medicine – Columbia

Ultrasound has proven to be a valuable active learning tool that can serve as a platform for integrating the medical student curriculum across many disciplines and clinical settings. Exposure to correlative learning elements of ultrasound imaging in the context of organ system-based pathology has been introduced/incorporated into the second-year medical pathology curriculum large group (lecture) and small group (case-based clinicopathologic discussion session) learner-teacher modules. Such contextual correlation serves to provide a broader, deeper knowledge base to students as well as facilitating the students’ purposeful transfer of basic science knowledge to the clinical diagnostic arena in the spirit of clinicopathologic correlation. Such a correlative approach to learning elements in pathology allows students to better associate imaging from two “visually (image)-rich” – and pattern recognition-based – disciplines (i.e. pathology and ultrasonography) and ultimately better support deep, purposeful learning and understanding of disease processes. This will better prepare students to acquire and apply such learning elements as they approach patient cases in the clinical phase of their undergraduate medical education, ultimately enhancing their diagnostic acumen as future physicians.

In the spirit of faculty development for participating pathologist educators in this innovative curricular initiative, and for the purposes of in-service interdisciplinary cross-training, the Medical Pathology course director, in close collaboration with faculty and staff of our institution’s integrated ultrasound curriculum (iUSC) and the director of our ultrasound institute (USI), has made available to all colleagues a resource package, including on-line learning sites, on-site workshops, textbooks, and journals.

115 – Pathology Education in Osteopathic Medical Schools
Sebastian Alston, Kevin Carnevale, and James Lyons
Alabama College of Osteopathic Medicine and Des Moines University College of Osteopathic Medicine

Pathology education in osteopathic education has both similarities and differences with allopathic medical education. In preclinical education of both traditions, pathology remains one of the curricular pillars that support diagnostic entities of clinical medicine and understanding of pathophysiology. In clinical education in both, pathology is essential in acquiring and understanding anatomic, clinical and other data and understanding that supports differential diagnosis and clinical reasoning. However, osteopathic education differs in the effects of a large amount of require osteopathic contact hours in the curriculum, added diagnoses and approaches to health and wellness, and differing accreditation and residency situations. This workshop will feature presentations/discussion of pathology curricula in member schools, discussions of various aspects and possible approaches to general and osteopathic-specific challenges, and general discussion. Establishment of a network of members in osteopathic settings is a definite objective of this workshop. Such discussion and network could lead to further discussion, data-gathering, and enhanced/improved approaches.

116 – Enhancing student Learning and Clinical Skills in the Pathology Classroom: An Innovative Strategy
Ritcha Saxena
ASU School of Medicine

A thorough understanding of pathology underpins meaningful medical education. A good pathology instruction calls for ensuring a systematic knowledge of pathophysiology, the foundation of clinical practice, along with incorporation of clinical skills. Currently, pathology education is going through a tight spot. The challenge the instructors of pathology face is the requirement to convey a large amount of information in limited duration. Enhancement of active leaning for medical students and meticulous assessment of teaching methods is the need of the hour. An organized integration of course materials along with synchronized team based learning and case presentations is required to intensify clinical application of concepts. This is a novel approach, but teaching case studies, with incorporation of pathology images, may not prove sufficient to help students learn and form logical correlations about the subject as it might prevent students from perceiving an eloquent and concise preclinical conception of disease. To overcome this impediment, an avant-garde approach of utilizing simultaneous amalgamation of gross and microscopic pathology with radiological imaging, was considered. Digitized macro and microscopic images, and radiological images of various systems were presented to the large group. The small group was given radiological teaching files with microscopic and gross imaging of existing pathological files and case studies, and they were asked to integrate them. The students were then cross examined by the instructors through various methods. Digitized macro and microscopic images with radiological images alongside clinical case studies not only helped learners assimilate a large amount of information in a smaller duration, but also provided them a good knowledge of diagnostic utility of imaging in a large number of clinical scenarios. Thus, clearer linkages of pathology and radiological imaging form the bedrock of evocative pathology education.

117 – Challenges and Strategies to increase engagement in the Pathology Lab Sessions
Fernando Pereira Bruno
Touro College of Osteopathic Medicine

In the past decade, the focus of medical education has shifted, leaving behind an outdated cluster of memorized facts for an improved model based on clinical applications. This made medical schools continuously adapt their curricula to accommodate new requirements for core competencies. Pre-clinical courses have followed suit by now, focusing more on how the initial basic science concepts translate into clinical practice. This allows medical students a clearer perspective of the topics’ relevance in their future careers.

When it comes to Pathology lab, virtual microscopy and digital gross anatomic-pathological images integrated to clinical case discussions seems to have gained popularity. This method substitutes the classic and static practice of gathering around a pathological specimen and discussing its morphological features. The use of digitalized images facilitates standardized learning by exposing all students to the same high yield specimens which best characterize the morphology they are supposed to master. Moreover, digitalized learning circumvents the challenges in obtaining real-life specimens and reduces the costs associated with laboratory equipment maintenance and specimen preparation and disposal. Also, discussing clinical cases, especially as a small group activity, helps the students brainstorm the pathophysiology they have learned and apply it to a scenario that helps mature their critical thinking without putting a real patient at risk. This converts into a format that enhances student learning, as they gain early exposure to a structure resembling the morning rounds.

Despite the many advantages, digitalized learning applied to a clinically focused curriculum also bears new challenges, most of which still require some fine-tuning. When removing the use of microscopes and real-life specimens, the benefits of a kinesthetic learning were lost. Besides, while computers can serve as a learning tool, they also introduce distractors that interfere with students’ in-class participation. Furthermore, the format of team-based learning applied to problem-solving doesn’t seem to be as effective when facilitators, such as additional adjunct faculty or tutors, are not available to assist the small groups, and instead the activity depends on a single faculty managing a large group. In summary, important elements of student engagement have been jeopardized, and new strategies are necessary to troubleshoot the classical Socratic method.