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Optimal Methods of Teaching Clinical Pathology

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  • 1. Optimal Methods of Teaching Clinical Pathology (Laboratory Medicine) to Medical Students Roger W. Geiss, M.D. University of Illinois College of Medicine at Peoria
  • 2. Proviso
    • IMHO
  • 3. Problems in the teaching of clinical pathology
    • Lack of a standard textbook
    • Difficult topic for lecture
      • not as amendable to pictorial illustration as is anatomic pathology
    • Concerns that material learned may be replaced in the clinical years by less reliable information
    • Others (?)
  • 4. Issues in the teaching of clinical pathology
    • WHAT to teach
    • WHEN to teach it
    • HOW to teach it
    • WHO should teach it
  • 5. Issues in the teaching of clinical pathology
    • WHAT to teach
      • principles of laboratory testing
        • analytic and statistical concepts
        • specimen processing and handling
        • proper use of laboratory tests
      • specific laboratory tests
        • indications
        • interpretation
        • limitations
  • 6. Issues in the teaching of clinical pathology
    • WHEN to teach it
      • A. preclinical years
      • B. clinical years
      • C. both
      • D. neither
  • 7. Issues in the teaching of clinical pathology
    • WHEN to teach it
      • A. preclinical years
      • B. clinical years
      • C. both
  • 8. Issues in the teaching of clinical pathology
    • WHEN to teach it
      • preclinical years
        • as part of pathology course
        • as part of organ segments
      • clinical years
        • M3
          • in conjunction with services/patients
          • specific sessions on lab medicine
        • M4
          • rotation
          • elective
      • both
        • preclinical years: teach proper utilization of laboratory tests
        • clinical years: reinforce proper utilization of laboratory tests
  • 9. Issues in the teaching of clinical pathology
    • HOW to teach it (preclinical)
      • course structure
        • separate clinical pathology course/module
        • integration
          • into general and systemic pathology
          • into systems-based curriculum
      • textbook
      • mode of instruction
    • OBJECTIVES
  • 10. Clinical pathology course/module
    • Advantages
      • students in lab medicine “mode”
    • Disadvantages
      • CP of a disease/system detached from AP and other aspects (“disintegration”)
    • Conclusion
      • students must incorporate lab medicine into clinical decision making
      • CP best taught in conjunction with other aspects of disease/system
  • 11. Issues in the teaching of clinical pathology
    • HOW to teach it (preclinical)
      • course structure
      • textbook
      • mode of instruction
    • OBJECTIVES
  • 12. Textbooks for clinical pathology
    • Standard pathology texts
      • Robbins & Cotran
      • Rubin’s
    • Designated clinical pathology texts
      • designed for medical students
      • not an encyclopedic source
    • Systemic texts
      • Schmaier & Petruzzelli, Hematology for Medical Students
      • Greenspan & Gardner, Basic & Clinical Endocrinology
    • Standard medical texts
      • Harrison’s
      • Cecil
  • 13. Standard pathology textbooks for teaching clinical pathology
    • Advantages
      • single text for pathology course/pathology portion of organ segments
      • close correlation with other aspects of disease/system
    • Disadvantages
      • emphasis is on anatomic pathology
      • variable coverage of clinical pathology topics
        • strong er
          • hematopathology
          • endocrinology
        • weaker
          • general principles of laboratory testing
          • renal pathology/urinalysis
      • minimal coverage of blood banking/transfusion medicine
    • Conclusion: supplementation needed
      • textbooks
      • handouts
  • 14. Systemic and standard medical textbooks for teaching clinical pathology
    • Advantages
      • texts used in other courses (ICM, organ systems)
      • close correlation with other aspects of disease/system
    • Disadvantages
      • variable coverage of clinical pathology topics
        • clinician-authored
        • pathologist-authored
      • frequently no coverage of general aspects of laboratory testing
    • Conclusions
      • choose carefully
      • may require supplementation
  • 15. Designated clinical pathology textbooks
    • Dufour Widmann’s
    • McKenna Laposata Mais
  • 16. BREVITY CURRENT LENGTH No BB/TM DATED COMMENTS DISCIPLINE SYSTEMIC SEMI- SYSTEMIC DISCIPLINE DISCIPLINE APPROACH +* + + + + GENERAL PRINCIPLES $75 $89 $75 $70 $49 PRICE (approx.) 270 569 571 1092 599 PAGES 2005 2002 2000 2000 1998 YEAR Mais (ASCP) Laposata (ASCP) McKenna (ASCP) Widmann’s (F.A. Davis) Dufour (LWW) BOOK
  • 17. Issues in the teaching of clinical pathology
    • HOW to teach it
      • course structure
      • textbook
      • mode of instruction
        • lecture: principles of laboratory medicine
        • small group: laboratory tests
          • case-based
          • problem-based
        • laboratory
        • independent/self-study: e.g., computer-based
        • other
      • OBJECTIVES (principles, tests)
        • separate CP objectives
        • subset of integrated objectives
  • 18. Objectives
    • For each session
      • lecture
      • small group
      • laboratory
      • independent study
      • reading assignment
    • For each unit
      • subject area within general pathology
      • organ system
  • 19. Objectives Have them!
  • 20. Issues in the teaching of clinical pathology
    • Who should teach
      • pathologists
        • faculty
        • residents
      • clinicians
        • good practitioners of laboratory medicine
        • supervision by pathologists
          • formal
          • informal
        • teaching assistants (TAs): e.g., M3, M4 students
          • need to be well-trained
          • less practical than in AP-based sessions
  • 21. Summary and Conclusions
    • WHAT to teach: clinical pathology (laboratory medicine)
    • WHEN to teach it: throughout curriculum
    • WHO should teach it: those best equipped
    • HOW to teach it
      • text ( + supplemented by additional materials)
      • lecture format works for learning general principles
      • case study format better for learning utilization of individual tests
      • OBJECTIVES
  • 22. References
    • Dufour, Clinical Use of Laboratory Data: A Practical Guide , Lippincott Williams & Wilkins, 1998.
    • Goldman & Ausiello, Cecil Textbook of Medicine (22 nd ed.), Saunders, 2004.
    • Greenspan & Gardner, Basic & Clinical Endocrinology (7 th ed.), McGraw-Hill, 2004.
    • Kasper, et. al., Harrison’s Principles of Internal Medicine (16 th ed.), McGraw-Hill, 2005.
    • Kumar, Abbas, & Fausto, Robbins & Cotran Pathologic Basis of Disease (7 th ed.), Elsevier Saunders, 2005
    • Laposata, Laboratory Medicine: Clinical Pathology in the Practice of Medicine , ASCP Press, 2002.
    • Mais, Quick Compendium of Clinical Pathology , ASCP Press, 2005.
    • McKenna & Keffer, The Handbook of Clinical Pathology (2 nd ed.), ASCP Press, 2000.
    • Rubin, et. al., Rubin’s Pathology: Clinicopathologic Foundations of Medicine (4 th . ed.), Lippincott Williams & Wilkins, 2005
    • Sacher & McPherson, Widmann’s Clinical Interpretation of Laboratory Tests (11 th ed.), F.A. Davis, 2000.
    • Schmaier & Petruzzelli, Hematology for Medical Students , Lippincott Williams & Wilkins, 2003.
  • 23. Thanks for your attention Questions? Comments?