Optimal Methods of Teaching Clinical Pathology

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Optimal Methods of Teaching Clinical Pathology

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

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