Optimal Methods of Teaching Clinical Pathology

Optimal Methods of Teaching Optimal Methods of Teaching Clinical Pathology (Laboratory Clinical Pathology (Laboratory Medicine) to Medical StudentsMedicine) to Medical Students

Roger W. Geiss, M.D.Roger W. Geiss, M.D.University of Illinois College of University of Illinois College of

Medicine at PeoriaMedicine at Peoria

ProvisoProviso

IMHOIMHO

Problems in the teaching of clinical Problems in the teaching of clinical pathologypathology

Lack of a standard textbookLack of a standard textbook

Difficult topic for lectureDifficult topic for lecture– not as amendable to pictorial illustration as is not as amendable to pictorial illustration as is

anatomic pathologyanatomic pathology

Concerns that material learned may be Concerns that material learned may be replaced in the clinical years by less replaced in the clinical years by less reliable informationreliable information

Others (?)Others (?)

Issues in the teaching of Issues in the teaching of clinical pathologyclinical pathology

WHAT to teachWHAT to teach

WHEN to teach itWHEN to teach it

HOW to teach itHOW to teach it

WHO should teach itWHO should teach it

Issues in the teaching of clinical Issues in the teaching of clinical pathologypathology

WHAT to teachWHAT to teach– principles of laboratory testingprinciples of laboratory testing

analytic and statistical conceptsanalytic and statistical conceptsspecimen processing and handlingspecimen processing and handlingproper use of laboratory testsproper use of laboratory tests

– specific laboratory testsspecific laboratory testsindicationsindicationsinterpretationinterpretationlimitationslimitations


WHEN to teach itWHEN to teach itA. preclinical yearsA. preclinical years

B. clinical yearsB. clinical years

C. bothC. both

D. neitherD. neither


WHEN to teach itWHEN to teach itA. preclinical yearsA. preclinical years

B. clinical yearsB. clinical years

C. bothC. both


WHEN to teach itWHEN to teach it– preclinical yearspreclinical years

as part of pathology courseas part of pathology courseas part of organ segmentsas part of organ segments

– clinical yearsclinical yearsM3M3

– in conjunction with services/patientsin conjunction with services/patients– specific sessions on lab medicinespecific sessions on lab medicine

M4M4– rotationrotation– electiveelective

– bothbothpreclinical years: teach proper utilization of laboratory testspreclinical years: teach proper utilization of laboratory testsclinical years: reinforce proper utilization of laboratory testsclinical years: reinforce proper utilization of laboratory tests


HOW to teach it (preclinical)HOW to teach it (preclinical)– course structurecourse structure

separate clinical pathology course/moduleseparate clinical pathology course/module

integrationintegration– into general and systemic pathologyinto general and systemic pathology

– into systems-based curriculuminto systems-based curriculum

– textbooktextbook– mode of instructionmode of instruction

OBJECTIVES OBJECTIVES

Clinical pathology course/moduleClinical pathology course/module

AdvantagesAdvantages– students in lab medicine “mode”students in lab medicine “mode”

DisadvantagesDisadvantages– CP of a disease/system detached from AP and other CP of a disease/system detached from AP and other

aspects (“disintegration”)aspects (“disintegration”)

ConclusionConclusion– students must incorporate lab medicine into clinical students must incorporate lab medicine into clinical

decision makingdecision making– CP best taught in conjunction with other aspects of CP best taught in conjunction with other aspects of

disease/system disease/system


HOW to teach it (preclinical)HOW to teach it (preclinical)–course structurecourse structure

–textbooktextbook

–mode of instructionmode of instruction

OBJECTIVESOBJECTIVES

Textbooks for clinical pathologyTextbooks for clinical pathology

Standard pathology textsStandard pathology texts– Robbins & CotranRobbins & Cotran– Rubin’sRubin’s

Designated clinical pathology textsDesignated clinical pathology texts– designed for medical studentsdesigned for medical students– notnot an encyclopedic source an encyclopedic source

Systemic textsSystemic texts– Schmaier & Petruzzelli, Schmaier & Petruzzelli, Hematology for Medical StudentsHematology for Medical Students– Greenspan & Gardner, Greenspan & Gardner, Basic & Clinical EndocrinologyBasic & Clinical Endocrinology

Standard medical texts Standard medical texts – Harrison’sHarrison’s– CecilCecil

Standard pathology textbooks for Standard pathology textbooks for teaching clinical pathologyteaching clinical pathology

AdvantagesAdvantages– single text for pathology course/pathology portion of organ segmentssingle text for pathology course/pathology portion of organ segments– close correlation with other aspects of disease/systemclose correlation with other aspects of disease/system

DisadvantagesDisadvantages– emphasis is on anatomic pathologyemphasis is on anatomic pathology– variable coverage of clinical pathology topicsvariable coverage of clinical pathology topics

strongstrongerer– hematopathologyhematopathology– endocrinologyendocrinology

weakerweaker– general principles of laboratory testinggeneral principles of laboratory testing– renal pathology/urinalysisrenal pathology/urinalysis

– minimal coverage of blood banking/transfusion medicineminimal coverage of blood banking/transfusion medicine

Conclusion: supplementation neededConclusion: supplementation needed– textbookstextbooks– handoutshandouts

Systemic and standard medical textbooks Systemic and standard medical textbooks for teaching clinical pathologyfor teaching clinical pathology

AdvantagesAdvantages– texts used in other courses (ICM, organ systems)texts used in other courses (ICM, organ systems)– close correlation with other aspects of disease/systemclose correlation with other aspects of disease/system

DisadvantagesDisadvantages– variable coverage of clinical pathology topicsvariable coverage of clinical pathology topics

clinician-authoredclinician-authoredpathologist-authoredpathologist-authored

– frequently no coverage of general aspects of laboratory frequently no coverage of general aspects of laboratory testingtesting

ConclusionsConclusions– choose choose carefullycarefully– may require supplementationmay require supplementation

Designated clinical pathology textbooksDesignated clinical pathology textbooks

DufourDufour Widmann’sWidmann’s

McKenna Laposata MaisMcKenna Laposata Mais

BOOKBOOK DufourDufour (LWW)(LWW)

Widmann’sWidmann’s (F.A. Davis)(F.A. Davis)

McKennaMcKenna (ASCP)(ASCP)

LaposataLaposata (ASCP)(ASCP)

MaisMais (ASCP)(ASCP)

YEARYEAR 19981998 20002000 20002000 20022002 20052005

PAGESPAGES 599599 10921092 571571 569569 270270

PRICE PRICE (approx.)(approx.)

$49$49 $70$70 $75$75 $89$89 $75$75

GENERAL GENERAL PRINCIPLESPRINCIPLES

++ ++ ++ ++ +*+*

APPROACHAPPROACH DISCIPLINEDISCIPLINE DISCIPLINEDISCIPLINE SEMI- SEMI- SYSTEMICSYSTEMIC

SYSTEMICSYSTEMIC DISCIPLINEDISCIPLINE

COMMENTSCOMMENTS No BB/TMNo BB/TM

DATEDDATED

LENGTHLENGTH BREVITYBREVITY

CURRENTCURRENT


HOW to teach itHOW to teach it– course structurecourse structure– textbooktextbook– mode of instructionmode of instruction

lecture: principles of laboratory medicinelecture: principles of laboratory medicinesmall group: laboratory testssmall group: laboratory tests

– case-basedcase-based– problem-basedproblem-based

laboratorylaboratoryindependent/self-study: e.g., computer-basedindependent/self-study: e.g., computer-basedotherother

– OBJECTIVESOBJECTIVES (principles, tests) (principles, tests)separate CP objectivesseparate CP objectivessubset of integrated objectives subset of integrated objectives

ObjectivesObjectives

For each sessionFor each session– lecturelecture– small groupsmall group– laboratorylaboratory– independent studyindependent study– reading assignmentreading assignment

For each unitFor each unit– subject area within general pathologysubject area within general pathology– organ systemorgan system

ObjectivesObjectives

Have them!Have them!


Who should teachWho should teach– pathologistspathologists

facultyfacultyresidentsresidents

– clinicianscliniciansgood practitioners of laboratory medicinegood practitioners of laboratory medicinesupervision by pathologistssupervision by pathologists

– formalformal– informalinformal

teaching assistants (TAs): e.g., M3, M4 studentsteaching assistants (TAs): e.g., M3, M4 students– need to be well-trainedneed to be well-trained– less practical than in AP-based sessionsless practical than in AP-based sessions

Summary and ConclusionsSummary and Conclusions

WHAT to teach: clinical pathology WHAT to teach: clinical pathology (laboratory medicine)(laboratory medicine)WHEN to teach it: throughout curriculumWHEN to teach it: throughout curriculumWHO should teach it: those best equippedWHO should teach it: those best equippedHOW to teach itHOW to teach it– text (text (++supplemented by additional materials)supplemented by additional materials)– lecture format works for learning general lecture format works for learning general

principlesprinciples– case study format better for learning utilization case study format better for learning utilization

of individual testsof individual tests– OBJECTIVESOBJECTIVES

ReferencesReferencesDufour, Dufour, Clinical Use of Laboratory Data: A Practical GuideClinical Use of Laboratory Data: A Practical Guide, , Lippincott Williams & Wilkins, 1998.Lippincott Williams & Wilkins, 1998.Goldman & Ausiello, Goldman & Ausiello, Cecil Textbook of MedicineCecil Textbook of Medicine (22 (22ndnd ed.), ed.), Saunders, 2004.Saunders, 2004.Greenspan & Gardner, Greenspan & Gardner, Basic & Clinical EndocrinologyBasic & Clinical Endocrinology (7 (7thth ed.), ed.), McGraw-Hill, 2004.McGraw-Hill, 2004.Kasper, et. al., Kasper, et. al., Harrison’s Principles of Internal MedicineHarrison’s Principles of Internal Medicine (16 (16thth ed.), ed.), McGraw-Hill, 2005.McGraw-Hill, 2005.Kumar, Abbas, & Fausto, Kumar, Abbas, & Fausto, Robbins & Cotran Pathologic Basis ofRobbins & Cotran Pathologic Basis of DiseaseDisease (7 (7thth ed.), Elsevier Saunders, 2005 ed.), Elsevier Saunders, 2005Laposata, Laposata, Laboratory Medicine:Laboratory Medicine: Clinical Pathology in the Practice ofClinical Pathology in the Practice of MedicineMedicine, ASCP Press, 2002., ASCP Press, 2002.Mais, Mais, Quick Quick Compendium of Clinical PathologyCompendium of Clinical Pathology, ASCP Press, 2005., ASCP Press, 2005.McKenna & Keffer, McKenna & Keffer, The Handbook of Clinical PathologyThe Handbook of Clinical Pathology (2 (2ndnd ed.), ed.), ASCP Press, 2000.ASCP Press, 2000.Rubin, et. al., Rubin, et. al., Rubin’s Pathology: Clinicopathologic Foundations of Rubin’s Pathology: Clinicopathologic Foundations of MedicineMedicine (4 (4thth. ed.), Lippincott Williams & Wilkins, 2005. ed.), Lippincott Williams & Wilkins, 2005Sacher & McPherson, Sacher & McPherson, Widmann’s Clinical Interpretation ofWidmann’s Clinical Interpretation of Laboratory TestsLaboratory Tests (11 (11thth ed.), F.A. Davis, 2000. ed.), F.A. Davis, 2000.Schmaier & Petruzzelli, Schmaier & Petruzzelli, Hematology for Medical StudentsHematology for Medical Students, Lippincott , Lippincott Williams & Wilkins, 2003.Williams & Wilkins, 2003.

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Optimal Methods of Teaching Clinical Pathology