101- Using the Donor Cadaver to Promote Professional Integrative Education Between Year 1 Medical Students and Pathology Assistant Students
by Jennifer Dreiling, MD & Maurice Fremont-Smith, MD Frank H. Netter, MD School of Medicine, Department of Medical Sciences

The structure of medical education has evolved from lecture-based instruction and rote memorization of scientific facts to implementation of an integrated, multidisciplinary curriculum that aims to promote active learning, improve retention and facilitate application to clinical practice via team-based and problem- based learning paradigms.

Objective: To design an interprofessional, integrative anatomy-pathology curriculum and to evaluate whether this form of integration across disciplines and professions affects student learning of normal and abnormal pathology and promotes a deeper appreciation of a multidisciplinary, team-based approach to patient care.

Design: Year 1 medical students at the Frank H. Netter, MD School of Medicine were divided into groups of 4 or 5 and assigned to a donor cadaver as part of an organ system-based anatomy curriculum.  A pathology assistant (PA) student was assigned to each anatomy table. Students were encouraged to identify normal and abnormal pathologies in their donor cadavers and obtain representative tissue samples during their dissections. PA students then performed frozen sections on the biopsied tissues. Gross pathology identification and frozen section diagnosis were rendered by one of two faculty pathologists. Faculty emphasis around the multiheaded microscope was placed on the clinical presentation, pathophysiology and natural history of the discovered disease processes. Each anatomy table was then charged with developing a short didactic presentation detailing the gross anatomy, histology, and pathophysiology of disease. At its Conclusion, medical students were invited to participate in an online survey to assess the effectiveness of this event.

Results: There were 41 responses to the online survey. 79% of respondents agreed that identification of disease and pathology in the donor cadaver enhanced their understanding of normal physiology. 87% of respondents agreed that the integrated anatomy-pathology event enhanced their perception of the importance of gross identification of disease and 79% agreed that the event enhanced their perception of the importance of histologic identification of disease. 71% of respondents agreed that the team didactic presentation at the Conclusion of the integrated event reinforced their learning experience and 61% agreed that working with PA students also reinforced their learning experience. 89% of survey respondents agreed that this integrated anatomy-pathology curricular event should be continued for future year one medical students. 21% of respondents agreed that the integrated anatomy-pathology event inspired them to reflect on a possible career in pathology, while 37% of respondents disagreed with this statement and 42% neither agreed nor disagreed with this statement.

Conclusions: Our school’s interprofessional, integrative anatomy-pathology curriculum enhanced year one medical student’s understanding of normal physiology, their perception of the importance of gross and histologic identification of disease, and the interprofessional and team didactic components reinforced medical students’ overall learning experience. The vast majority of survey participants felt that this experience should be continued for future classes. We plan to continue this integrative curriculum for future year one medical students and intend to incorporate further interprofessional collaboration including radiologic examination of donor cadavers. We further propose to assess the effectiveness of this event on PA student learning via a similar survey analysis.

102 – Maximizing the Educational Benefit of Anatomical Donors
by Quayd Robertson Arkansas College of Osteopathic Medicine

Quayd Robertson, Addie Hancock, Kayla Bird, Garrett Snell, Cody Blackstone, Joshua Gaunt, Oliver Hancock, Ed Rysal, Chase Sorrels, Dr. William Zaloga, Dr. Rakesh Singh, Heather Guzik

The traditional Anatomy curriculum at the graduate level focuses on gross anatomical relationships. We used the opportunity of our anatomical department to fully maximize a preexisting resource, the donors, to incorporate a novel hands-on pathologic approach that is not typically presented in preclinical curriculum. To establish our unique paradigm, an examination following autopsy procedures was performed on a donor. The autopsy revealed lung lesions consisting of nodules and surface adhesions that were primarily localized on the outer surface of the lungs. Sections of the lesions were prepared on sight and sent to the Pathology Services Laboratory in Russellville, Arkansas for subsequent analysis. Our general gross assessment of the bronchopulmonary tree, lung nodules, surface adhesions, cervical, paratracheal and bronchopulmonary lymph nodes led us to the following initial diagnoses: adenocarcinoma, squamous cell carcinoma, and mesothelioma. Adenocarcinoma more often presents in the lung periphery, whereas squamous cell carcinoma typically is identified in the hilar/central region of the lung. Our histological findings are more indicative of a non-small cell carcinoma. We deliberated and decided to obtain the following immunohistological stains (CK7, CK20, P63, TTF1, and Calretinin) in order to provide a definitive diagnosis of adenocarcinoma, squamous cell carcinoma, or mesothelioma. Our findings were later compared with the available medical history (death certificate) which recorded supraglottic cancer with lung metastasis as the cause of death. Performing the autopsy was an initial exposure to pathological science and the processes by which lung pathologies present. The use of the anatomical donors for education is not limited to gross anatomy but can provide many educational opportunities.

103 – Students as partners to develop an integrated pathology teaching resource using innovative technology tool (Adaptive learning platform) in the MD program
by Ashlee Malone | Jolanta Kowalewska MD, PhD | Rajasekaran Koteeswaran MD, MBBS Eastern Virginia Medical School | Eastern Virginia Medical School | Eastern Virginia Medical School

Introduction: With digital tools available today, educators can design a learning activity that engages the learner with interactive images, assessment tools, and instant feedback. With disciplines such as pathology in an integrated medical school curriculum, this can be a valuable tool. However, educators may have limited time to make these pathology-centered learning activities and can only view them through an educator’s perspective. Medical students can help educators by offering their learner perspective, time, and skills with technology to assist educators. This not only allows the student to assist the educator but a way to expose the student to pathology.
The main objective of this project is to evaluate the degree of engagement in the learning activities developed by MD students using a technology platform and to develop an integrated pathology teaching resource.

Methods: A student has created an integrated pathology learning activity using BEST and Smart Sparrow with the assistance of medical school educators. The learning activity is based on content taught in the skin, muscle and bone module for M1 students at Eastern Virginia Medical School (EVMS). At the end of the lesson, a survey with a 5-point Likert scale questionnaire was included to evaluate the effectiveness of engagement, accessibility, the value in understanding the topic and if they would like to see more activities like this. A comment section is also added for feedback. The activity was deployed to students of the MD class of 2022 at EVMS.

Results: 21 students volunteered to try the activity. Based on the survey: 86% of students strongly agreed or agreed that the activity was interesting and engaging. 62% of students strongly agreed or agreed that they would like to see more activities like this. 62% students strongly agreed or agreed that the lesson was easy to navigate through. 76% students strongly agreed or agreed that the lesson was valuable in understanding the topic. Most comments suggested changes with formatting and technical issues.

Conclusion: Based on the feedback, partnering with a student in creating an integrated pathology teaching resource was effective in engaging learners and helping them understand the topic. Valuable feedback was also obtained regarding student preference for formatting that can be used for future learning activities.

105 – Illustrations of Histology: Review Video Lecture Supplementation to MS1 Histology Course
by Christopher Demas, B.S. | Joyce Ou, M.D., Ph.D. | Corey Hanley, M.D. The Warren Alpert Medical School of Brown University | Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University; Women and Infants Hospital, Providence, Rhode Island | Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University; Women and Infants Hospital, Providence, Rhode Island

Introduction: Video lecture supplements for live lecture-based academic courses have been shown to increase positive perception of course content and may lead to an improvement in course grades. This project involved taking a creative approach to generate educational videos for first-year medical students enrolled in the Alpert Medical School (AMS) histology course. The aim of this project was to test both the educational effectiveness and the student perception of supplemental video lectures to the AMS histology curriculum.

Methods: A total of 9 video review lectures were generated by the authors. Developing the review content involved video-recording the creation of hand-drawn images. Following the drawing phase, the recordings speed was increased to create a moving animation and a narration of the drawing was added to the video to describe the illustrations. The end product was a series of pictures come to life mini-lecture reviews that covered core histology topics in approximately 5- to 10-minute videos. These videos were accompanied by short pre- and post-quizzes to assess students understanding and gauge the usefulness of the videos as a supplement to the existing curriculum. Review videos were delivered to AMS MD22 students through the use of a Canvas module after the material had been covered in the existing histology course lecture series. Each module contained a video review lecture as well as a pre- and post-quiz. Students were instructed to take the pre- quiz, watch the review lecture, and then take the post quiz. A crossover design was used to randomize the questions for the pre- and post-quiz for each review module. Students were included in the study only if they completed both the pre-quiz and post-quiz. Survey data was additionally collected through a validated approach on the students perceptions of the videos with a scale from 1 to 5 for each module (1 = not at all helpful; 2 = somewhat helpful; 3 = moderately helpful; 4 = very helpful; and 5 = extremely helpful).

Results: In the subset of students who watched the videos and completed both quizzes (64/146 MD22 students; 44%), there was a significant increase from pre- to post-quiz scores for 3 out of the 9 video modules delivered (Figure 1). A total of 8 of 9 video review lectures received ratings between 4 and 5, indicating that students found the videos either to be very helpful or extremely helpful (Figure 1).

Conclusion: Overall, first-year medical students who participated in this study by watching the lecture review videos and completing the quizzes, appeared to benefit from supplemental video learning content for the AMS histology course. Results from the pre- and post-quizes showed a trend of improvement in the students understanding of the review material. Additionally, 3 modules specifically demonstrated a significant increase in understanding via post-quiz score improvements (P=0.05). Overall, supplemental video lecture materials were well-received and appear to be an effective way to help medical students learn histology.

106 – Hands-on Microscope Sessions as an Introduction to Pathology for Medical Students
by Andrew Bernhisel Medical student

The Purpose of this poster is to explore Methods of increasing medical students  exposure to the science and work of being a pathologist, along with recommendations for implementation and delivery in a manner consistent with students  knowledge and learning styles.

Methods: Pathology education has been described as a core subject, the link between basic science and clinical medicine (Carr, Olmos, & Bushnell, 2008). Despite the importance of pathology as a medical profession, many pathology residency programs remain unfilled after the residency match (Results and Data, 2009). While pathology is one of the most critical subjects that students learn in the first two years of their medical education, there appears to be a disconnect between the pathology content students learn and their understanding of pathology as a career choice. To determine the extent to which medical school education exposes students to pathology and prepares them to choose pathology as their career, a literature search was done to explore the ways that pathology instruction shapes students learning and preferences.

Results: In recent years, medical school curriculum in the United States has sought greater integration of different subspecialties of basic and clinical medical science, as well as more hands-on experience (Brauer & Ferguson, 2014; Funk et. al., 2012). Within national pathology education standards, however, there is no standard recommendation for exposing students to the day-to-day work of pathology or sharing hands-on experience (Sadofsky, Knollmann-Ritschel, Conran, & Prystowsky, 2014). Further, many medical schools do not offer a pathology elective to students until their final year, when it may be too late for them to seriously consider pathology as a career. Because pathology has so many differences from many other clinical specialties in medicine, hands-on experience with pathologists who show the work they do and how it fits in to the bigger picture of medicine could greatly enhance pathology’s visibility with medical students. Some programs have experimented with and shown positive Results with a hands-on approach to pathology education, but there remains much room for growth (Funk et. al., 2012).

Conclusion: Because of a shortage of pathologists in the United States and deficits shown in pathology education, it is important that new Methods of increasing the exposure and experience of pathology be shared from physicians to students. One possible effective solution could be implementation of optional sessions where a pathologist teaches students using a multi headed microscope and specimens that relate to the unit or body system they are studying. At Texas Tech University Health Science Center El Pasos Paul L. Foster School of Medicine, such a program has been shown to be effective at introducing students to microscopes and pathology in a relaxed and hands-on way. For most students, this is the first personalized time they have with a pathologist and the impact can be a sparked interest in learning more about the specialty. Implementation of hands-on experiences can be one step in a larger picture of increasing pathology visibility among students.

107 – Autopsy Visits: Fostering Medical Student Awareness of Pathology
by Morgan Gallo | Andrew Bernhisel | Osvaldo Padilla Paul L. Foster School of Medicine | Paul L. Foster School of Medicine | Paul L. Foster School of Medicine

Introduction: Pathology remains a somewhat mysterious practice to patients and even to those working in healthcare. Many medical students have little or no awareness of pathology upon matriculation and are often first introduced to pathology during their preclinical lectures, occurring sometime within the first 2 years of school. One method of increasing pathology awareness among medical students is to offer clinical pathology experiences during the pre-clinical learning period.

Methods: The Paul L. Foster School of Medicine has found great success and popularity with scheduling monthly visits to the medical examiner’s office, which are open to medical students of all years. In addition to observing and assisting with autopsies, students are able to meet with the medical examiner, ask questions in a relaxed environment, and learn about forensic and general pathology. Because the autopsy visits primarily attract first and second year students, they often serve as a student’s first experience in working with a pathologist. Autopsy sessions are coordinated by a student leader, which allows for especially interested students to develop connections with working pathologists.

Results: Overall, regular autopsy sessions have shown to be an effective and feasible way of increasing awareness of pathology among medical students.

Conclusions: Programs of similar basis have the potential to inspire future collaborations between medical schools and their local medical examiner’s office, evidenced by the recent addition of a fourth year selective rotation in forensic pathology at the Paul L. Foster School of Medicine.

108 – What’s Common is Not Always Common: Challenges Illustrating Disease Pathology for Medical Education
by Larry Nichols Mercer University School of Medicine

The goal of medical education is to produce competent physicians. Pathology provides a bridge between basic science, and the clinical practice of medicine, aiding medical students in becoming competent at applying their knowledge of basic science. Undergraduate medical education (UME) has shifted from lectures to formats like flipped-classrooms of active learning. The new curricular approaches pose a challenge to some disciplines. One of the challenges in pathology is an insufficient number of cases that illustrate common diseases. Students would benefit from learning how to see common pathology before being presented with the complexities of real patient cases in real time and case reports in the medical literature.

Mercer University School of Medicine (MUSM) incorporates the teaching of pathology in various ways including Image of the Day (IoD) practice questions, team-based learning opportunities, and integration of gross anatomy and pathology. The IoD practice questions provide a clinical scenario including an image of gross or microscopic pathology and then ask a multiple-choice board exam style question, which allows students to make clinicopathologic correlations at the time they are studying the pathophysiology of the disease. Team-based and case-based learning offers an opportunity for students to be able study the history and physical exam of a patient and determine the necessary laboratory testing. MUSM students who discover gross pathology at anatomy cadaver dissection are enabled to have slides made and to see the direct pathologic correlates of anatomical findings. The use of digital slides and virtual microscopy has revolutionized the opportunities available to students studying pathology and allows for students to view and study slides highlighted by instructors along with viewing supplemental slides to strengthen their understanding.As no two medical students learn the same, integrative UME curricula with solutions similar to those in practice at MUSM and other universities offer opportunities to strengthen students understanding and knowledge of clinicopathologic disease processes.

109 – What are the most influential experiences offered at PLFSOM that spark interest in pathology?
by Christina Shreve | Daniel Bustamante Texas Tech University Health Sciences Center of El Paso | Texas Tech University Health Sciences Center of El Paso

Purpose: The Purpose of this study is to determine what educational tools medical students at the Paul L. Foster School of Medicine (PLFSOM) are exposed to that spark their interest in the field of Pathology. This is invaluable information to have, as it can be used to determine what is effective and what is less effective at making Pathology visible to medical students.

Methods: Current PLFSOM students and recent graduates, who are interested in or who have chosen Pathology as a career choice, were surveyed and asked to evaluate different types of exposures to the field of Pathology that they endured during their medical school curriculum. On a scale of 1 to 5, with 5 being the most influential and 1 being the least influential, students decided how impactful the exposure had been. A final free response question was available at the end of the survey for the respondent to list any other factors that had been influential in their interest in Pathology that had not been previously mentioned in the survey. A total of 13 respondents filled out the survey including second, third, and fourth year medical students as well as PLFSOM graduates currently doing a pathology residency. The scores given for each exposure were then averaged.

Results: The Results of the study showed that the most influential tools were pathology rotations, autopsy sessions, self-study, and mentorship. Pathology Interest Group meetings and Pathoma were moderately influential. The least influential tools were pathology lectures, worked case example, and pathology grand rounds. Other factors that were mentioned in the free-response section as being influential included a prior professional experience.

Conclusion: In Conclusion, it appears that pathology lectures and coursework, the most common and earliest exposures to the field, are not engaging students into the field of Pathology as much as previously thought. Although pathology rotations were tied for the most influential, medical students do not have the opportunity to experience this until third or fourth year. It is then essential to engage students in pathology their first and second year through the other exposures mentioned. The fact that self-study was ranked so highly suggests that many students are learning about pathology through their own research and not what medical school is offering them. Since mentorship was one of the highest-ranking exposures, it is important for pathologists to consider how invaluable their time and experience is in influencing medical students to go into the field.

Other medical schools who do not offer the exposures that were influential such as a Pathology Interest Group should consider establishing such groups and/or practices. One of the most influential tools and experiences our Medical school now offers is a student-organized, monthly autopsy session. This is an innovative example that shows how student leaders and peer interest may now be at the forefront in promoting intrigue and awareness. As a result, this overall sense of camaraderie and unity will no doubt help spark interests as well as set standards for the future of the field and practice of Pathology.

110 – Pathophysiology as Non-Credit Self-Directed Learning for Medical Students
by Tipsuda Junsanto-Bahri, MD | Christine Lomiguen, MD | Mark Terrell, EdD Touro College of Osteopathic Medicine | Lake Erie College of Osteopathic Medicine | Lake Erie College of Osteopathic Medicine

Purpose: Feedback from medical students who had recently taken their licensure examinations included the need for curriculum offerings in Pathophysiology, rather than strictly Pathology and Physiology taught as separate subjects. Additionally, recent changes to the accreditation of colleges of osteopathic medicine resulted in a new standard requiring self-directed learning experiences within the curriculum to enable students to acquire skills for long-lasting learning, inclusive of self-assessments and independent recognition and processing of information. To help an urban osteopathic medical school meet this new standard, an optional, non-credit online supplemental curriculum in Pathophysiology was developed to better prepare second-year medical students for the interdisciplinary level of higher-order questions on the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) Level 1 and United States Medical Licensing Examination (USMLE) Step 1.

Methods: Cognitive theories of learning were used during the curriculum development process to emphasize that the transfer of new knowledge to long-term memory is supported and enhanced when conceptual understanding at initial presentation is utilized coupled with the application and practice of new knowledge through use of multiple examples and real-life experiences. The curriculum was aligned with the examination schedule of the second-year Systemic Pathology II curriculum and integrated concepts from the Systemic Pathology I, General Pathology, and Physiology courses. Twelve (12) pathophysiology question sets were created, each with three higher-order, board-style questions. The curriculum was delivered through the course management system in online quiz format for students to take. A cumulative final exam was made available at the end of the course and consisted of fifty board-style pathophysiology questions from all topic areas. Answer explanations and references were provided to promote learning through formative feedback. Students were allowed three (3) attempts for each question.

Results: Positive preliminary feedback was received from the program’s initial implementation in the Spring 2019 semester. Medical students are considered adult learners who are capable of independent learning activities; thus, the option for self-directed learning of a high-yield content area was met with appreciation. Because the Pathophysiology curriculum was delivered in a non-credit, non-graded, optional manner, which could be accessed and taken any time during the semester, students felt Pathology professors were respectful of their limited study time while providing them with a useful resource for challenging, critical thinking questions, which could be used as a self-assessment in preparation for board examinations.

Conclusion: Analysis of satisfaction surveys suggest that educational strategies at the medical education level must include imparting more responsibility on future doctors for their own learning through work in small groups, active discussion sessions, problem-based approaches, while concomitantly reducing sessions involving formal teaching. Further research will quantitatively examine effectiveness of this curriculum on national licensing examination scores.

111 – Integrating Pathology Into a Systems-Based Curriculum at a New Public Allopathic Medical School in Nevada
by Amalie Alver, MS | Neil Haycocks, MD, PhD University of Nevada, Las Vegas School of Medicine | University of Nevada, Las Vegas School of Medicine

Purpose: To examine the longitudinal incorporation of histology and pathology into an active-learning basic science curriculum.

Background: Nevada is ranked 47th in the country for number of active physicians, and thirty percent of these physicians are over the age of 60. However, retention of students who complete both undergraduate and graduate medical education in Nevada is higher than the national average (1). As the population continues to grow, the need for more physicians across all specialties is vital to the health of the community. Nationally, pathology continues to be an underfilled specialty even as pathologists rank among the top in satisfaction and lowest in burnout (2). To address this physician deficit the University of Nevada, Las Vegas (UNLV) founded a public medical school in 2014 with a pathologist, Dr. Barbara Atkinson, as the Founding Dean. Increasing student understanding of the role of the pathologist while in medical school, both in clinical practice and academic medicine, may help to overcome the pathologist deficit in Nevada.

Methods: The integrated organ-system course design at UNLV introduces students to normal physiology and pathology in tandem. The teaching of pathology and pathophysiology is interwoven between clinicians and pathologists. Events combine histological slides with images of gross anatomy in an attempt to provide a more clinic-based presentation with relevant application to students. By utilizing pathologists to teach students in an integrated fashion, students may more thoroughly understand the role of the pathologist in the treatment of the patient. The concurrent anatomy course is also novel at UNLV. Students use touchscreen Sectra tables and complete virtual dissections in order to integrate imaging technology with human anatomy. With continued advancements in technology, students interested in pursuing pathology will need to embrace updated Methods of analysis and diagnosis (3). This style of education may allow students to feel more comfortable embracing rapidly evolving technology in the future. To allow further exploration of the field, the local coroner’s office allows interested students to shadow at their convenience. Over 15% of currently enrolled students at our medical school have pursued this opportunity, indicating a strong interest in the specialty relative to previously identified norms (4).

Results and Conclusions: Incorporating traditionally isolated courses into one continuous, integrated class provides clinician educators flexibility to schedule their course time. Students may be more likely to understand the sometimes abstract connections between histologic and gross presentation of disease. This will be enhanced as histopathology is gradually incorporated into the virtual anatomy teaching. As the charter class graduates in 2021, data will be gathered at a future time to analyze the effectiveness of our innovative curriculum in student performance, specialty preference and physician retention.

112 – The Pathology Interest Group: Enhancing Exposure of Pathology Among Medical Students
by Allison Chang | Meaghan Dougher | Prisca Obidike | Aesha Shah | Nicole Williams, M.D. | Natalie Yoshioka Penn State College of Medicine | Penn State College of Medicine | Penn State College of Medicine | Penn State College of Medicine | Penn State College of Medicine | Penn State College of Medicine

Medical student interest groups offer unique and valuable opportunities for students to explore a variety of career paths. Unfortunately, research on interest group impact with regards to their value as a source of career development and medical education is scarce. With the decline in pathologist workforce predicted to continue through 2030, earlier exposure to the field is needed to increase awareness and interest of pathology as a potential career path. This study aims to evaluate the impact of pathology interest group events and activities on student medical education.

The pathology interest group intends to deliver early exposure to medical students by holding events such as lunch lectures, microscope sessions, and fundraisers. Lectures which feature resident panels offer students a chance to listen to resident experiences, a typical day in the life of a pathologist, and examples of patient cases. The detailed accounts of residents provide a clear picture of the role of the pathologist, how a pathologist obtains and interprets tissue samples, and the responsibilities that are unique to a pathologist.

The question and answer aspect of these lectures allows students to discover the tasks of a pathologist which are not widely emphasized. Furthermore, the interest group serves to facilitate the learning of pathology for medical students. Microscope sessions and small group discussions give students the opportunity for a one-on-one walkthrough of the reading of histology slides, and pathologic findings which enhance student’s understanding of pathology for exams and practice. Such small discussions are especially effective when pertaining to the current organ block of the curriculum. In order to increase the value of subsequent events, feedback surveys are sent to attendees to gauge effectiveness after each event. With the ability to strengthen the students knowledge of histology, there will be an increased interest and confidence in pursuing a future in pathology.

Earlier exposure to the specialty of pathology has increased awareness of the field as a potential career path, expanded interest in pursuing elective rotations in pathology in clerkships, and enhanced understanding of basic histology principles and relevant organ block pathologies. The activities of the interest group have filled a key gap in medical education with the absence of a core pathology block in the curriculum at this institution. Pathologies discussed during other organ blocks have been expanded upon in more intimate settings with pathologists who are able to delve into the details of the disease and illustrate key differences between the pathology and the expected normal histology. Feedback surveys sent to attendees of such lectures have expressed the value of the group activities and indicate further gaps of knowledge in histology and pathology that students would like the group to focus on in future events. Supplemented experiences on pathology by the pathology interest group has enhanced the quality of the medical education as evaluated by students and observed by the leaders of the group.

113 – Enhancing Student Learning by Integrating Anatomy, Physiology and Histology in Pathology Teaching
by Jing Meng Bastyr University

Enhancing Student Learning by Integrating Anatomy, Physiology and Histology in Pathology Teaching. Our first-year medical school curriculum is horizontally integrated. Normal structures and functions are taught in courses on Anatomy, Physiology, Histology, Embryology, and Biochemistry. The second-year curriculum is comprised of horizontally integrated courses of Pathology, Immunology, Infectious Diseases, Naturopathic Clinical Diagnosis, Pharmacology, and associated laboratories. Students are expected to pass the NPLEX 1 (Naturopathic Physicians Licensing Examination 1) upon finishing these courses.

Second year pathology is designed to discuss the basis of all diseases. First-year education is foundational for optimal performance in second-year pathology. Vertically integrating normal structures and functions to the study of the corresponding abnormal conditions is key for student success. As an interdisciplinary faculty team, we sought to vertically integrate Histology, Anatomy and Physiology to Pathology teaching. The goal of this educational research is to assess the impact of this integration on student learning.

Throughout the second year, we provide content on related Anatomy, Physiology and Histology critical learning objectives as online study material in conjunction with Pathology. In the classroom, relevant key concepts of normal structures and functions are summarized, followed by discussion of corresponding disease processes. Further, we take second-year students back into the Cadaver Anatomy lab where we cross-check concepts of Anatomy and Pathology by examining cadavers. Each of these lab visits allows students to relate what they are learning in the classroom with actual diseases

To assess the impact of this vertical integration on student learning, students are pre-tested in a pathology class at the beginning of year two, and are post-tested at the end of that school year on the same set of multiple choice questions covering pathology concepts as well as key concepts of Anatomy, Physiology and Histology. Data was analyzed by t-test.

Two-hundred thirty-two (232) ND students from three academic years were exposed to vertically integrated pathology teaching and completed the assessment. Average performance was 46% on the pre-test, and 67% on post-test. Paired t-tests showed a significant increase in the overall performance of students through vertically integrated pathology education (P -0.05), with a significantly higher retention rate of year one concepts (P -0.05).

Sixty-two (62) ND students from a previous academic year without exposure to vertically integrated pathology teaching were tested on the same questions at the end of year two. Their average performance was 58% at the end of year two. The cohort of students that completed the pathology discipline integrated with normal structures and functions achieved significantly higher performance, mastering basic pathology concepts and solving comprehensive case problems, when compared to the cohort of students without training on vertically integrated pathology (P -0.05).

Conclusion: Vertically integrating normal structures and functions to Pathology teaching enhances student learning experiences in a second-year medical school curriculum.

114 – Assessing the need for traditional microscopy skills in integrated pathology curricula
by Swati Mahapatra | Selah Mauldin | Blandine Bustamante Helfrich MD MPH Student Researcher | Student Researcher | Faculty Sponsor

Purpose: The teaching of pathology has shifted from the utilization of traditional microscopy to that of virtual microscopy. University of the Incarnate Word School of Osteopathic Medicine (UIWSOM) has a unique integrated, case-based, and learner centered curriculum. UIWSOM uses virtual, digitized images as a part of its integrated curriculum to facilitate learning of the pathologic basis of disease by osteopathic medical students. We wanted to investigate whether the UIWSOM pathology curriculum, consisting strictly of virtual microscopy, could be improved by the addition of traditional microscopy slides, and whether it would enhance our understanding of pathology as pre-clinical osteopathic medical students. We performed a literature review comparing the efficacy of virtual microscopy to that of the traditional microscopy approach to pathology, using reported studies which implemented both, compared to those which implemented solely traditional microscopy in their medical education curricula.

Methods: We searched Access Medicine, PubMed, and Google Scholar databases using the combined search terms pathology medical education, pathology education gross specimens, integrative curriculum and pathology curriculum. We independently screened titles and abstracts and then collaborated to reach an agreement on what articles to retrieve. Each article was examined for information pertinent to our question of whether traditional microscopy slide usage could improve our understanding of pathology. Studies comparing the effectiveness of different pathology curriculum styles were used.

Result: Medical students utilizing virtual microscopy in an integrated curriculum had the best Results, as measured by student satisfaction and test performance. In one study, two cohorts of pre-clinical medical students were evaluated one was taught using a traditional approach and one using an integrated approach. The integrated approach consisted of digital images, theoretical approaches, and clinical cases, whereas the traditional approach consisted of auditorium-based lectures and laboratory sessions involving traditional microscopy. Another study, in which traditional microscopy was substituted for digital microscopy, yielded similar Results. Students and facilitators preferred using the digital images, along with integration of case histories, radiological images, and laboratory data. Thus, the transition from traditional microscopy to virtual microscopy does not appear to negatively affect pre-clinical pathology education. However, it may fail to prepare students with basic microscopy skills needed for certain specialties. Additional training, such as a one and one-half day boot camp can provide supplemental training for students interested in specialties like pathology, where laboratory medicine is a vital diagnostic tool. Implementation of short, additional training periods during the clinical years helped compensate for the lack of hands-on skills in the virtual microscopy approach to pathology.

Conclusion: This literature review discusses the efficacy of virtual microscopy over traditional microscopy in the classroom. While the integrative approach with virtual microscopy improves learning of pathology, it may be reinforced and improved upon at UIWSOM by incorporating basic microscopy skills later in the curriculum for those students interested in pathology residencies pathology.

115 – Multi-faceted approach to engaging medical students in pathology
David J. Escobar, MD, PhD | Jean V. Fischer, MD | Farres Obeidin, MD | Kruti P. Maniar, MD | Kristy L. Wolniak, MD, PhD | Luis Z. Blanco, MD Department of Pathology – Northwestern University Feinberg School of Medicine | Department of Pathology – Northwestern University Feinberg School of Medicine | Department of Pathology – Northwestern University Feinberg School of Medicine | Department of Pathology – Northwestern University Feinberg School of Medicine | Department of Pathology – Northwestern University Feinberg School of Medicine | Department of Pathology – Northwestern University Feinberg School of Medicine

Purpose: Current trends in medical school education have been to transition away from traditional didactic course-based curriculum to an integrative systems-based model. Concurrently, the number of United States medical school graduates matching into pathology residency has shown continuous decline. A recent survey (Hsieh, AJCP /2015) investigated the learning experiences of pathology residents during medical school training and found that 50% of respondents felt comfortable in their knowledge of normal histology and surgical pathology. Many medical students may not become aware of pathology as a medical specialty until late in their training. To increase medical student exposure to pathology as a field of medicine and improve pathology education for students choosing a pathology rotation during medical school we strove to undertake a multi-faceted approach to student outreach.

Methods: To promote visibility of the pathology department, especially anatomic pathology, among first and second year medical students (pre-clinical), extra-curricular one-hour slide review sessions covering topics aligned with the medical school curriculum were scheduled in coordination with the pathology student interest group. The sessions were conducted at the department multi-headed microscope, led by a PGY2 or higher pathology resident. At the end of the academic year, a survey was distributed to any student who attended at least one session to gauge interest and receive student feedback.

For clinical phase students rotating in pathology, a glass slide box of greater than 100 high-yield pathology cases specifically tailored for medical students was designed to increase medical student engagement during pathology electives. Students were encouraged to utilize the glass slide set and increase familiarity with operation of a microscope. Additionally, the slide set was digitally scanned, providing off-site access to the cases. Pre- and post-rotation surveys were designed and administered to assess medical students’ interest in pathology and to gauge effectiveness of the slide box.

Overlaid on these efforts, pathology residents across all years of training have additional opportunities to interact with pre-clinical phase students in the formal medical curriculum. Through the use of multi-Purpose and multi-media collaborative learning space, pathology residents directly interacted with pre-clinical students.

Results: An average of 15-18 students attended each glass slide multi-headed microscope review session. An estimated 8-10 students attended most or all of the sessions offered. Overall, at least 48 students attended at least one session. Feedback from all students was positive. Survey Results are currently being collected. Pre- and post-rotation surveys for students rotating in pathology to assess effectiveness of and attitudes toward the high-yield case teaching slide box are currently being collected.

Conclusions: The task of engaging pre-clinical and clinical phase medical students in pathology education is increasingly challenging in the face of changes in pedagogical Methods at United States medical schools. We describe a multi-faceted approach to engage medical students in pathology education. Through the use of resident-led slide review sessions, pre-clinical phase students are exposed to the field of pathology before starting clinical clerkships. Students who choose to pursue an elective in pathology are engaged with high- yield teaching cases to increase their comfort with tissue examination and operation of a microscope

116 – An Integrated Pathology Experience: Bridging Outside Resources with the Classroom
by Sarah Li | Gregory Yim | Tipsuda Junsanto-Bahri | Christine Lomiguen Touro College of Osteopathic Medicine | Touro College of Osteopathic Medicine | Touro College of Osteopathic Medicine | Lake Erie College of Osteopathic Medicine

Background: USMLE Step 1 scores heavily influence a medical student’s residency program prospects where a low score can undermine an entire application. In addition to encompassing 45-52% of this exam, knowledge in pathology is also critical for understanding other basic sciences and establishing a strong foundation for a future career as a physician. Recently, medical students are increasingly prioritizing self-study outside of the classroom with online resources, which offer comprehensive material for board exams with the added benefit of learning at ones own pace. In online post-board exam reviews, UFAPS (UWorld, First Aid, Pathoma, and Sketchy) is often anecdotally regarded as mandatory and suggested to students seeking board preparation advice.

With increased student dependence on outside resources to study for board examinations, it is important to start a discussion between students and professors regarding their pathology education. Understanding why students are turning towards other resources despite readily available institutional materials could bridge the disconnect between what professors are teaching and the resources students are learning from.

Methods: Anecdotal post-exam reviews were gathered from various online medical student forums (SDN, Reddit, etc.). Reviews were chosen based on the online user’s self-reported board scores and focused on those that were greater than one standard deviation above the 2018 average Step 1 board score of 231.

Results: After reviewing over fifty post-exam online posts, 90% of students reported using outside resources to help achieve success on board examinations. One study conducted on 3rd year medical students who recently completed their board exams has shown that 8% of students surveyed believed that school curriculum alone provided sufficient preparation for the pathology component of board examinations. The vast majority of students indicated that outside resources were key in successfully preparing for boards, with some suggesting that integrating outside resources with institutional lectures would be beneficial. At our institution, pathology professors reference relevant chapters and videos from popular online resources in their lectures to align with student interests. Students have found this helpful because the online resources provide a strong foundation which can be further developed in classroom discussions. Thus, professors can focus on providing a more integrated insight into pathology. Referencing the same information through various teaching modalities may help students solidify fundamental pathology concepts and excel in both the classroom and standardized exams.

Conclusions: With the recent increase in popularity and availability of online board prep resources, it becomes increasingly important for medical school educators to consider how their students are learning for institutional and standardized board examinations. Students are increasingly resorting to resources that provide the most efficient, yet comprehensive materials. In order for lectures to not become obsolete, there should be dialogue between professors and students regarding how to best prepare for examinations. This could help professors gain valuable feedback into student preferences and give students insight into their professors’ perspectives, ultimately encouraging students to reprioritize their time to the classroom.

117 – Benefits of Teaching Microscopy Techniques in Pre-Clinical Medical School Curriculum
by Tyler Williamson UIWSOM

Introduction: This review surveys the literature published on the benefits of teaching conventional light microscopy techniques in the pre-clinical medical school curriculum. My clinical observations suggested the hypothesis that the use and teaching of conventional light microscopy slide techniques is beneficial before the beginning of clerkships in the integrated medical school curriculum.

Discussion: The University of the Incarnate Word School of Osteopathic Medicine (UIWSOM) solely employs the use of modern technology to integrate clinical histology and digitized images into the innovative, problem-based curriculum. The use of digital technologies, such as virtual microscopy, in pathology courses has largely replaced its predecessor, the conventional light microscope, throughout undergraduate medical education. Medical students overwhelmingly prefer the use of virtual microscopy and digital imaging to learn histopathology, and it is well proven that these two convey significant advantages over conventional microscopy in teaching (1). While most practicing physicians do not use the microscope, there is reason to support a medical student’s need to learn microscopy techniques (2). The skills needed to operate a conventional light microscope still have many applications in the fields of certain specialties, such as internal medicine, pathology, and hematology/oncology (4). Many physicians in the primary care clinic will use the microscope to look at gram stains, urine sediments, and blood smears (2). According to a research survey, 90% of physicians still believe it is important to have microscope skills and a general understanding of microscopy for practice. It was also observed the majority of these physicians utilize a microscope for diagnosis in the clinic and hospital setting (5). Even more so, literature conveys the ability to utilize microscopes is needed much earlier than in future practice. Without proper teaching of microscope techniques, students are often not prepared to perform during clinical rotations (5). While some students and physicians may never utilize a microscope, it is quite important for their medical school education to empower them with the necessary tools and skills early on, prior to their rotations and residencies, to not limit their choices by abandoning a useful laboratory skill. Likewise, it is imperative that the pre-clinical medical education be modified to meet both the needs of the curriculum and the clinical practice thereafter.

Conclusion: With a primary care focus, the UIWSOM sets its mission to equip its students with the necessary tools early on to be successful future physicians in the community. Due to the abundant use of the microscope in the field of medicine, UIWSOM should provide the students with a knowledgeable understanding of microscopy techniques, through instruction and application alongside the current pathology curriculum, to fulfill the school’s mission to the community.

118 – The Differences Of Medical Educational System Between University Of California San Francisco And Tsinghua University On Pathology Course
by Ying Qiu | Fangli Ren | Raga Ramachandran | Marta Margeta Department of pathology, School of Medicine, Tsinghua University, Beijing 100084, China | Department of pathology, School of Medicine, Tsinghua University, Beijing 100084, China | Department of pathology, School of Medicine, UCSF, California, US | Department of pathology, School of Medicine, UCSF, California, US

Background: In China, medical education has experienced a long-term traditional educational model, which is mostly conducted through by lectures. Under this situation, teacher always was a learning center, students totally followed teacher as a passive learner. Tsinghua University, as a one of most famous university in China, strongly felt that only delivered knowledge form instructors couldn’t to solve the real complex clinical problems.

Medical program and Pedagogies in Tsinghua University: Tsinghua University carried out their own medical educational program called Physician Scientists MD Program (PSMDP).

The project features a full two-year overseas scientific research training in eight years of medical training. The aim is to cultivate students’ awareness of scientific exploration, master scientific research Methods, and become a clinical doctor with innovative consciousness. In this project, pathology course was reformed based on outcome-based education (OBE) theory. Case discussion with concept map construction, Problem- based learning (PBL), Clinical Pathology conference (CPC) stimulated learning, and other modes were adopted in pathology course. A multi-evaluation system was performed instead of the one-way approach of assessment. The reformed teaching model has greatly improved students learning initiative, but still cannot be separated from the constraints of the traditional system.

Medical program and Pedagogies in UCSF: In order to gain a deeper understanding of medical teaching in the United States, the author, as a visiting scholar, went to UCSF for a half-year work exchange in the fall of 2018. At UCSF, the Purpose of medical education</u> is to educate learners who will improve the health of communities and alleviate suffering due to illness and disease in patients. The MD program objectives are defined by seven core competencies: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, systems-based practice, and interprofessional collaboration. Compared with other medical schools in the United States, the most unique feature of the Bridges Curriculum in UCSF teaching is fully integrated delivered over four years. Student assessment in the Bridges Curriculum is also designed to meet multiple goals, such as providing ongoing feedback to students about their learning, promoting deep learning, critical thinking, retention of knowledge, and habits of inquiry aligned with the Bridges Curriculum mission, preparing students to excel on USMLE licensing exams, and so on.

Conclusion: Based on the comparison and exchange the medical education system and pathology teaching Methods between the two schools, we think if Tsinghua university could use the UCSF curriculum’s fully integrated model to Tsinghua’s pathology course, students’ comprehensive ability would be improved and it will stimulate students more motivations. The two schools have their own strengths in teaching resources. If the teaching resources can be shared, it will be more conducive to the medical education for the benefit of mankind. We encourage the Chinese government to provide more educators to American universities for short-term exchanges. This field exchange is more accurate and comprehensive in understanding medical education concepts.

201 – Proposed Integration of Mandatory Anatomic Pathology and Clinical Pathology Components into the Clerkship Curriculum
by Heather Jones | Osvaldo Padilla TTUHSC PLFSOM | TTUHSC PLFSOM

Purpose: Lack of exposure to the field of pathology is often cited as a major contributor to low medical student interest and therefore low rates of US graduates matching into pathology residencies. Although pathology is well-established as a basic science component of the preclinical curriculum, required pathology exposure is estimated to be present in less than half of medical schools during clinical years, when most students choose their future medical specialties. In fact, one of the most important factors that influence medical student career path is previous positive clerkship experience, second only to personal interest in one study. Without seeing pathology in clinical care or having the opportunity to find role models and mentors in this field, students don’t seriously consider pathology as a potential career path when exploring clerkships.

Methods: Performed a non-systematic literature review to examine how exposure to pathology during clinical training impacted medical student interest in pathology. Used the Results of this review to guide the formation of a proposal to alter Texas Tech University Health Sciences Center Paul L. Foster School of Medicine (TTUHSC PLFSOM) third year curriculum in order to increase student exposure to pathology.

Results: There are several common challenges encountered when proposing changes to the clerkship curriculum: resistance from clerkship directors, competition between specialties for student time, and insufficient pathology faculty. Additionally, even with successful implementation of increased pathology exposure, the efficacy of interventions is difficult to measure. However, the potential benefits of increasing pathology exposure in the clinical years extend beyond increasing the interest of students in pathology careers. Because physicians in all specialties work with pathologists, basic knowledge about the uses, limitations, and expectations for laboratory and tissue testing will benefit all future physicians.

Conclusions: To combat the ignorance of students about the daily practice and clinical role of pathologists, I propose the incorporation of a mandatory pathology-related component into two of the six core clinical rotations during third year at TTUHSC PLFSOM. First, I propose the addition of a clinical pathology component during the internal medicine rotation to address the lack of knowledge of both students and practicing physicians regarding the utilization of laboratory tests. This clinical pathology component could consist of a half-day dedicated to learning about the daily operations of the clinical laboratory and a lecture regarding appropriate ordering, interpretation, and timing expectations of lab tests. This could be implemented as one of the weekly half-day lectures that occur throughout the internal medicine rotation or incorporated as an afternoon activity to follow the clerkship orientation. Second, I propose the addition of an anatomic pathology component to the surgery curriculum. I suggest the addition of a requirement to follow one or more surgical specimens from the operating room to the pathology department for grossing, processing, and analysis. This requirement could easily be added as an item on one of the checklists already used to document the completion of other required components. The implementation of these changes would benefit both the pathology profession and medicine as a whole.

202 – Don’t Just Survive, Thrive: Improving Pathology Education to Enhance Small-Group Performance in an Integrated Curriculum Guided by Self-Directed Learning.
by Samantha Studvick | Andrew Nassralla | Amy Ko | Blandine Bustamante-Helfrich, MD, MPH University of the Incarnate Word School of Osteopathic Medicine | University of the Incarnate Word School of Osteopathic Medicine | University of the Incarnate Word School of Osteopathic Medicine | University of the Incarnate Word School of Osteopathic Medicine

Purpose: At University of the Incarnate Word School of Osteopathic Medicine (UIWSOM) the pathologic basis of disease is taught in an integrated curriculum in small and large group sessions. Despite a novel curricular design, it was found learners were not engaged. To better understand some challenges with delivery of our pathology curriculum (including, but not limited to, a noticeable decrease in both participation and attendance), we analyzed learner motivation driving the apathetic behavior, rather than focusing on curricular content or delivery. Here we focus on the relationship between the facilitation of pathology-based content in an integrated curriculum guided by self-directed learning (SDL) with the establishment of individual motivation that enhances overall small-group performance.

Methods: After establishing a challenge question, we utilized the online search engines, Google Scholar and EBSCOhost, to collect research and broaden our perspective regarding the balance between individual motivation and success in a SDL-derived curriculum. Examples of keywords included “self-directed learning,” “pathology in integrated curricula,” and “intrinsic motivation.”

Results: Due to the novel curricular design at UIWSOM, research which completely aligned with the school’s specific educational framework were scarce. Medical education has been under constant evolution in the last century, with the goal of preparing medical students to flourish into future physicians dedicated to life- long learning in the ever-expanding breath of medical knowledge. While changes in curricula implemented at various medical schools have proven to be successful strategies with regards to content delivery, our literature review raised the possibility that perhaps adult learners are neither fully prepared nor motivated for SDL and integrated curricula. Further research suggests gradually introducing SDL through a series of orientations may ease the transition into application of SDL in small group sessions. Additionally, by giving increased and positive feedback to students, as well as providing appropriately challenging tasks to perform, faculty can help cultivate an environment where students feel motivated to participate and grow.

Conclusion: We propose two solutions to combat the identified challenge in our curriculum. First, we advocate for an increase in external (from faculty) and internal (from learners) group monitoring to encourage accountability and ensure efficacy of learner-learner interactions during class time. By assigning individual roles to learners (such as “leader” or “scribe”), we may see a smoother integration of learners into our SDL-dependent, histopathology lab sessions. Second, we suggest the implementation of novel, interactive activities during class time to increase attainment of learning outcomes by deepening learners intrinsic motivation to contribute to the group. The future direction of this project involves surveying our colleagues and receiving their input to further dissect individual motivation as well as gain feedback from our peers.

203 – Pathology Teaching in Different Undergraduate Medical Curricula Within and Outside the United States
Kevin Carnevale MD | Ritcha Saxena MD | Lindsay Nelson | Geoffrey A. Talmon MD | Amy Lin MD | Osvaldo Padilla, MD, MPH | Regina A. Kreisle, MD, Ph.D. Des Moines University | Medical University of the Americas | Des Moines University | University of Nebraska Medical Center | University of Illinois  Chicago | Texas Tech University Health Sciences Center El Paso | Purdue University

Pathology education is taught using different curricula in the United States (USA) and abroad. There are may different versions, but they are categorized into three main components which include integrated, semi- integrated and traditional curricula. We evaluate and compare the hours spent in different forms of pathology teaching such as lectures, team-based learning (TBL), problem-based learning (PBL), and other Methods to teach general and systemic pathology amongst different medical schools within the USA and outside the USA.

Lecture hours, TBL hours, PBL hours, and hours spent in other forms of teaching pathology subjects were counted and compared in general pathology and systems pathology subjects in seven USA medical schools and six medical schools outside the USA.

The total number of lecture hours taught in general and systemic pathology was greater in outside schools than within the USA (141 hours vs 97.8 hours, respectively). The only subjects with more lecture hours taught in the USA were cardiac pathology, liver pathology, central nervous system pathology, and transfusion medicine. Most other subjects taught in general pathology and systems pathology had significantly less lecture hours in USA schools compared to outside medical schools. The greatest difference was the hours spent in labs were significantly longer for both general and systems pathology in schools outside the USA. The overall utilization of PBL was much greater outside the USA compared to within the USA (average overall hours PBL 97.2 outside vs 16.5 in USA), however, the reverse was observed for using TBL to teach both general and systemic pathology (average overall hours TBL (59.5 outside vs 84.5 in USA). Average hours used with other Methods of teaching was also greater in outside medical schools compared USA medical schools (80.8 hours vs 44 hours, respectively).

Conclusion: Pathology teaching in both general and systemic pathology has more extensive lecture hours, laboratory hours, PBL, and other Methods of teaching pathology in outside medical schools with different curricula than USA medical schools. TBL is utilized more extensively in USA medial schools.

204 – Building a Digital Pathology Education Resource for the University of Minnesota Medical School-Duluth Campus
by Paige Carlson University of Minnesota Medical School-Duluth

Our project is to build and develop an online digital pathology education resource for the University of Minnesota Medical School-Duluth. The slides will be organized into different modules that correspond to the first- and second-year courses. The clinical cases with classic morphology are chosen from the learning objectives published by the Undergraduate Medical Education Committee of the Association of Pathology Chairs. Instead of static images, we use virtual microscopy for viewing at various magnifications allowing the ability to navigate the slide. This provides undergraduate medical students with the opportunity to interact with slides that would normally not be available to them. Hopefully, this will help stimulate interest in the study of pathology.

Cases will be identified using the pathology database at Essentia St. Mary’s in Duluth, MN. Essentials compliance department has reviewed and approved the process. IRB review and patient authorization are not necessary because the slide scans with the educational format will not have labels, de-identifying the data. Slides with the classic morphology that are relevant to the cases will be pulled and scanned into the database. The scanning is with an Aperio whole slide imager at the Pathology Department at St. Mary’s. The whole slide image files are moved to the University of Minnesota Medical School-Duluth MD and uploaded to the Elevator application. A classic clinical scenario with a case history, lab values, leading questions, and teaching points are added to provide students a realistic clinical scenario for case-based learning. Important areas of interest on the slides will also be annotated to assist students in learning the classic pathology from the normal morphology.

Currently, we are unsure how the database will affect student learning long-term as we have only partially implemented it in the 2018-2019 curriculum. Early student feedback is encouraging as students indicated that it would be helpful to utilize Elevator slides more in teaching/presentations. We are looking to implement it more fully throughout the 2019-2020 curriculum in both the lecture format classes as well as the problem-based and other interactive learning sessions. This will hopefully stimulate interest in the field of pathology and make it more accessible for undergraduate medical students.

We are building an online digital pathology education resource for the University of Minnesota Medical School-Duluth. The goal is a comprehensive pathology resource, encompassing all the pathology competencies for medical education outlined by the Association of Pathology Chairs. This resource is available to all medical students and medical educators regardless of institution but is tailored for the curriculum at the University of Minnesota Medical School-Duluth.