A Simple Model for Improving Pathology Curricula - PowerPoint PPT Presentation

1 / 54
About This Presentation
Title:

A Simple Model for Improving Pathology Curricula

Description:

Clinical Experience. Clinical. Pre-Clinical. Pathology at the Center of the Flexner Model ... A scientific understanding of disease aids in clinical practice ... – PowerPoint PPT presentation

Number of Views:79
Avg rating:3.0/5.0
Slides: 55
Provided by: regi84
Category:

less

Transcript and Presenter's Notes

Title: A Simple Model for Improving Pathology Curricula


1
A Simple Model for Improving Pathology Curricula
  • Regina Kreisle, MD, PhD
  • Lafayette Center for Medical Education
  • at Purdue University, Lafayette, Indiana
  • Indiana University School of Medicine

2
Searching for Solutions
  • What is the best curricular format to teach
    Pathology?
  • How can Pathology gain more control over
    curricular issues?
  • What should be taught?
  • What role should the laboratory play?
  • How do we recruit students as future Pathologists?

3
Major Concerns
  • Pathology is being squeezed out of the curriculum
    by other priorities
  • Pathology is losing control over the teaching of
    Pathology as a discipline
  • Our opportunities to recruit students into
    Pathology are diminishing
  • Teaching resources are becoming more scarce
  • Income concerns place clinical/research effort
    over teaching

4
A Traditional Approach to Pathology Education
  • Many hours of lecture, often based on kodachrome
    slides
  • Many more hours in the laboratory
  • Gross specimens
  • Histopathology using glass slides
  • Autopsy and other discipline-specific experiences
  • Emphasis on the scientific basis of disease
    processes

5
A Traditional Approach to Pathology Education
  • A discipline-based approach to the understanding
    of disease processes that taught as much about
    being a Pathologist as it did about the subject
    of Pathology

6
Historical Perspective
  • Traditional approach born as a result of a
    revolution in medical education
  • Placed an understanding of the scientific basis
    of disease first and foremost in the study of
    medicine
  • Pathology was perfectly suited to be the
    centerpiece of this style of curricular approach
  • Basic philosophy and approach unchanged for 80
    years

7
(No Transcript)
8
Pre-Clinical
9
Pathology at the Center of the Flexner Model
  • Emphasized a basic science understanding of
    disease
  • Utilized scientific method in investigating
    disease processes
  • Bridged basic and clinical sciences
  • The Pathologist as a medical academician

10
Problems with the Traditional Flexner Model
  • Aimed at introducing laboratory science to
    medical students
  • Artificially separated basic science and clinical
    science
  • (over) Emphasized mastery of an extensive
    knowledge base
  • Time-intensive students had little time for
    study or self-directed learning

11
Core Principles of the Flexner Model
  • A scientific understanding of disease aids in
    clinical practice
  • Teaching medical science as scientific
    investigation results in good problem-solving and
    lifelong learning skills
  • Experiencing disease processes through laboratory
    experiences enhances an understanding of disease
  • Showcased Pathology as a discipline/specialty

12
Challenges to traditional undergraduate pathology
curricula
  • Exponential expansion in scientific knowledge
  • Decrease in the number of lecture hours
  • Decrease in the number of laboratory hours
  • Decrease in the availability of teaching
    materials
  • Increase in demand for self-directed learning
    modalities

13
Challenges to traditional undergraduate pathology
curricula, contd.
  • horizontal integration of clinical and basic
    science courses
  • vertical integration of courses
  • Increased emphasis on skills and attitudes in
    addition to knowledge (competency-based
    curriculum)
  • Competition between clinical practice (and/or
    research) and teaching efforts

14
New Directions in Medical Education
  • Increase in self-directed and active learning
  • Increased integration of basic sciences and
    clinical science
  • Focus on skills, behaviors, and attitudes
    required to be a doctor, not just basic science
    knowledge

15
New Curricular Initiatives
  • PBL (problem-based learning)
  • Integrated (not discipline-based) curricula
  • Competency-based curricula

16
PBL (problem-based learning)
  • Students acquire knowledge by generating
    case-based learning issues
  • Student-directed learning with minimal faculty
    direction
  • Emphasis on problem-solving and lifelong learning
    skills rather than detailed facts
  • Integration of clinical science and basic medical
    science

17
PBL (problem-based learning)
  • Strengths
  • Problem-solving skills
  • Self-directed learning
  • Life-long learning skills
  • Self-confidence
  • Team-work and communication skills

18
PBL (problem-based learning)
  • Problems
  • ?mastery of fund of knowledge
  • Decreased detail/breadth of knowledge
  • Little faculty guidance, role-modeling
  • Pathology lost as a discipline/medical specialty
  • Little student exposure to pathology
    specimens/slides
  • Faculty-intensive more faculty needed to cover
    multiple small groups
  • Requires new facilities, resources

19
PBL (problem-based learning)
  • Attempts to improve PBL
  • Development of clear and broad learning
    objectives (in addition to student-identified
    learning issues)
  • Supplemental lectures/labs on key subjects

20
PBL (problem-based learning)
  • What we have learned
  • Students are smart and capable of learning
    anything they feel is important to learn
  • Direct transfer of knowledge from professors to
    students is not required
  • Students enjoy the clinical applications they
    put more effort into things they like
  • They appear to be able to function in the
    clinical setting without having learned every
    detail about every subject (because they know how
    to continue learning)

21
PBL (problem-based learning)
  • Does it work?
  • Difficult to measure using knowledge-based
    assessment tools such as Board examinations
  • PBL and traditional students bring different
    skills and knowledge base to the clinics the
    differences disappear by graduation
  • No study to date shows superiority or inferiority
  • No studies available on effect of PBL on
    specialty choices such as Pathology

22
Integrated Curricula
  • Vertical integration of different disciplines in
    a single course organized by organ system
  • May involve all aspects normal and abnormal
  • May focus only on disease-based disciplines
    medicine, pathology, pharmacology
  • Teaching often dominated by a single discipline
    (i.e., medicine)

23
Integrated Curricula
  • Strengths
  • Students learn different aspects of the disease
    process at one time
  • Minimizes redundancy in didactic presentations
  • Students integrate different approaches to a
    disease process

24
Integrated Curricula
  • Problems
  • Minimal time given Pathology often focuses
    solely on morphologic features of disease
  • Pathogenesis covered (if at all) by other
    disciplines
  • Pathology lost as a discipline/medical specialty
  • Courses usually focus on specific disease
    entities rather than survey of pathologic
    processes affecting an organ system

25
Integrated Curricula
  • Does it work?
  • Too soon to tell regarding student proficiency
  • Students appear to like the integrative aspects
  • Eliminate benefits of planned redundancy
  • Accountability for the curriculum by specific
    disciplines is removed
  • Often requires more centralized educational
    services (not departmental)

26
Competency Based Curricula
  • Most recent challenge in Medical School Curricula
  • Can be combined with any of the commonly used
    formats Traditional, PBL, Integrated
  • Aspects will likely be required by all
    undergraduate medical programs in the near future
    (currently required of all residency programs)

27
Competency Based Curricula
  • Departs from Flexner approach
  • Begins with an assessment of the desired
    qualities (knowledge, skills, attitudes,
    behaviors) that should be possessed by all
    medical school graduates
  • Requires that assessments and evaluations of
    these qualities be incorporated at all levels of
    undergraduate medical education

28
Competency-based approach asks
  • What do you want your end product to be?
  • What are the knowledge, attributes, skills,
    attitudes, and behaviors that all students should
    demonstrate when they graduate from medical
    school?

29
MSOP
  • Physicians must be altruistic, altruistic and
    truthful.
  • Physicians must be knowledgeable about the
    scientific basis of medicine.
  • Physicians must be skillful in communicating with
    and caring for patients.
  • Physicians must be dutiful in working with other
    to promote the health of individual patients and
    the broader community.

30
Brown University/Indiana UniversityThe Nine
Competencies
  • I. Effective Communication
  • II. Basic Clinical Skills
  • III. Basic Science Knowledge
  • IV. Lifelong Learning
  • V. Self-Awareness and Self Care
  • VI. Social and Community Context of Health Care
  • VII. Moral Reasoning and Ethical Judgment
  • VIII. Problem-Solving
  • IX. Professionalism and Role Recognition

31
Competency-Based Education
  • Implies that skills, attitudes, and behaviors are
    as important as knowledge base
  • Incorporates formal assessments of desired
    competencies
  • Competencies are woven throughout curriculum
    (even in basic sciences)

32
So what are the Core Medical Competencies that
can be addressed in the Undergraduate Medical
Curriculum (especially by Pathology)?
33
Think about
  • Knowledge base
  • Skills/applications
  • Communication
  • Problem-solving
  • Data interpretation
  • Life-long learning
  • Attitudes
  • Professionalism
  • Ethics

34
Core Competencies Core Values
  • Knowledge of disease-associated structural
    changes
  • Knowledge of pathophysiology
  • Clinical problem solving
  • Interpretation of laboratory data
  • Interpretation of gross and histopathology
  • Appropriate use of descriptive terminology
  • Knowledge of the role of the pathologist
  • Communication with other members of the health
    care team
  • Ability to access relevant information sources
  • Ability to incorporate new knowledge as it
    becomes available
  • Etc.

35
Working Towards Balance
Knowledge Base
Undergraduate Pathology Education
Learning Skills
Clinical Integration
Role Modeling
36
Knowledge
  • Develop a set of clear learning objectives for
    your discipline
  • Focus on teaching the pathogenesis of disease
  • Use morphology and clinical pathology to
    illustrate the pathogenesis

37
Clinical Integration the role is important
38
Negative Messages
  • Medicine doesnt cover it, so it must not be very
    important to being a clinician
  • Pathology as a discipline is only interested in
    tissues, not the patient
  • Since I am interested in the patient and dont
    want to limit myself to reading slides, I dont
    want to be a Pathologist
  • Pathology is irrelevant and a waste of time

39
Pathogenesis-Centered Pathology Education
40
Positive Messages
  • Pathology contributes my understanding of all
    aspects of the patients experience of the
    disease
  • Pathology plays a critical role in diagnosis and
    clinical decision making
  • The Pathologist is obviously a respected member
    of the health care team
  • I want to be a Pathologist

41
Developing Competencies
  • Exercises to develop problem-solving skills
  • Use information gathered through pathology
    resources (laboratory, histopathology, autopsies,
    etc.)
  • Encourage the testing of hypotheses and
    development of differential diagnoses
  • Encourage the development of lifelong learning
    skills by focusing on our continually evolving
    understanding of pathogenesis
  • Develop vocabulary and communication skills

42
Role-modeling
  • Demonstrate enthusiasm for scientific inquiry and
    lifelong learning
  • Demonstrate clinical problem solving using
    pathology as a means of collecting information
    and testing hypotheses
  • Demonstrate how all aspects of clinical medicine
    derive from a thorough understanding of the
    pathogenesis of the disease

43
Role-modeling, contd.
  • Demonstrate how pathologists contribute to the
    health care team
  • Encourage discipline-specific activities and
    experience (i.e., autopsy, clinical electives)
  • Make sure students are introduced to pathologists
    early in their careers

44
The Bottom Line
  • No single curriculum or format is superior to all
    others
  • All four key components can play a role in any
    format
  • All four key components should be present in the
    curriculum, regardless of the format

45
Improving Traditional Discipline-based Curricula
  • Define specific objectives for the course
  • Use laboratories to illustrate key concepts (not
    teach diagnostic pathology)
  • Add active learning components (small group, case
    discussions, etc.) to develop skills and
    attitudes
  • Use faculty that can serve as good role-models

46
Working Towards Balance
Knowledge Base
Undergraduate Pathology Education
Learning Skills
Clinical Integration
Role Modeling
47
Improving PBL Curricula
  • Use Pathology faculty as tutors
  • Develop specific pathology objectives to
    supplement the students learning objectives
  • Make available resources to help the students
    with their learning objectives (image libraries,
    gross tissues, online resources, etc.)

48
PBL, contd.
  • Provide supportive learning opportunities
    (selective lectures, lab experiences)
  • Encourage the use of information derived from
    pathology services in the development of cases
  • Encourage the students to use the pathology
    faculty as primary resources for their learning
    issues

49
Improving Integrated Curricula
  • Provide specific discipline-based learning
    objectives for your contribution to the course
  • Focus the pathology contributions on
    pathogenesis, not just morphology
  • The course should be organized so that
    Pathologists are seen as valued members of the
    health care team, not a purveyor of irrelevant
    details

50
Integrated Curricula, contd.
  • Play a role in the administration of the course
  • Participate in the central administration of the
    curriculum as a stake-holder be willing to offer
    more to the education of medical students than
    histopathology slides and gross specimens

51
Improving Competency-based Curricular
  • Embrace the competencies that best fit the
    practice of Pathology
  • Develop specific course objectives for both
    knowledge base and skills/attitudes
  • Include course components to develop and assess
    skills and attitudes as well as knowledge

52
Competency-based Curricular, contd.
  • Demonstrate to students that pathologists value
    all aspects of the students education
  • Make sure faculty are good role-models for all of
    the values embodied by the competencies

53
Working Towards Balance
Knowledge Base
Undergraduate Pathology Education
Learning Skills
Clinical Integration
Role Modeling
54
Finding Your Way
  • Develop discipline-based learning resources
  • Employ enthusiastic and caring faculty for direct
    contact with students
  • Develop a core of Pathology faculty to advocate
    for undergraduate pathology education at
    departmental and university levels
Write a Comment
User Comments (0)
About PowerShow.com