Pathology Teaching for the Millennial Student

1. Pathology Teaching for the Millennial Student

3. Dr. Amira Gohara • Trained in pathology in Egypt and U.K. • Came to Toledo in 1970 • Resident • Faculty member • Chair of Pathology • Dean of Medicine • President of MCO • Emeritus 2005 • Developed pathology clinical curriculum • Double Golden Apple recipient x 6 • Outstanding Teaching Award, MCO • Outstanding Teaching Award, UT • Student hooder > 9 straight years

4. Outcome Class of 2015 13 UT students pursued pathology as a career

5. Student’s Profile • Most are junior AOA • Most have Step 1 scores ≥ 250 • The top graduating student joined the residency program at Emory University

6. Where Did They Go?

7. Clinical experience in pathology for University of Toledo students Currently we have seven electives in pathology, one during the foundational sciences period and six during the clinical years. They are very popular and very well received by the students. In 2015/2016, we had 522 rotations.

8. Number of clerks Year

9. What is Pathology in the mind of a medical student?

10. PathologyThe pumping heart of Medicine VEINS ARTERIES Questions from clinicians regarding slides Lab tests Autopsy findings • Diagnosis • Lab test interpretation • Clinicopathologic correlations on autopsies • Consultant rounds with clinicians

11. Valves • Managing utilization of lab tests Costs of tests

12. Central role of Pathology Internist Surgeon Radiologist Pathologist ER Doctor A Team! Kidney transplant

13. How can we get the message out to medical students regarding what pathologists do?

14. Travel with them through their 4 year medical school journey

15. Pathology Club Advisor 1st Year Current Curriculum Lab Vignette Elective 2017 New Curriculum Longitudinal Foundational Science Years

16. Current Organ Systems 2nd Year Physiology Pharmacology Step 1 Strategy & Tutoring Pathology New Curriculum (Integrated System Based Foundational Sciences

17. Sophomore pathology (current) Lectures - Vignette based Questions related to vignette including: • Lab tests • Morphology • CPC

18. Small group sessions - all vignette-based A 25-year-old man works in a military fuel depot. He began having respiratory difficulty along with red-tinged sputum. Two months later, he had increasing malaise and flank pain. He went to see the base physician. The patient then developed very rapid onset of renal failure with hematuria within three days. What tests and procedures would you order? What is the differential diagnosis? What additional laboratory tests can be ordered?

20. 3rd Year New Curriculum Laboratory Medicine/Pathology rotation as a graduation requirement Current 3rd Year Elective Clerkship Post-Sophomore Fellowship

21. 4th Year Pathology Electives Case Studies Pathology/Radiology Clerkship Independent Study Pathology Clerkship Strategies for Step 2 CK LORs Mentoring Recruiting

22. Clinical clerkship: Radiology/Pathology

23. Pathology Clerkships (176 students) • Partner each student with a resident or fellow mentor • Mini-histology course on day 1 of rotation • Use of the Simulation Center for hands-on experience in FNA and autopsy • Practice frozen sections with Pathologist’s Assistant (autopsy tissues) • Grossing, sign-out, and consensus conference • Microbiology rounds with head technologist • Scope time with Dr. Gohara: archival teaching slides • Neuropathology time with Dr. Mrak: Gross neuropathology powerpoints • Topic presentations. Examples: • Wet prep • Pathology of breast cancer • Imaging in breast diseases • HPV • Non-pathologic variables that impact lab tests • Custom-tailored special rotations: • Dermatopathology • Neuropathology • Microbiology

26. Case Studies (176 students) • 18-20 Students • 3 cases per day • Interactive • Discussion of diseases related to cases • Step 2 CK prep

27. Independent Study (160 students) • Literature search • Summary paper

28. Seniors Who has the answers for Mr. Jones’ clinical dilemma? Let me go talk to Dr. Gohara…

29. Student evaluations of clinical clerkships in pathology Our current elective clinical clerkships are • more highly rated than any current required core clerkship (average rating 3.84/4.0) • often mentioned in our graduation questionnaire as one of the most valued experiences in the College of Medicine

30. 2017: A new curriculum Interactive learning case/team orientated Flipped class room More small groups (8 students per group) and Team or group based learning

31. The new curriculum will include a 2-week, required Laboratory Med/Pathology clinical clerkship We proposed the creation of a 2-week, required laboratory medicine/pathology clerkship as a graduation requirement. This was approved by the Clinical Curriculum and Executive Curriculum Committee in 2016.

32. Approved Lab Medicine Pathology/Radiology Graduation Requirement The rotation will include: THE LABORATORY MEDICINE EXPERIENCEwill include cost effective laboratory utilization, indications and interpretations of laboratory tests, as well as turnaround time. BASIC SURGICAL PATHOLOGYincluding frozen sections, grossing specimens and sign-out. CYTOPATHOLOGY AND FNA will be an integral part of the rotation. THE AUTOPSY EXPERIENCE will include how to discuss the need for an autopsy with the family, obtaining an autopsy permit, participating in a real cadaver autopsy at the Simulation Center and filling out the death certificate. CLINICAL GENOMICS EXPERIENCE is also included.

33. Pathology/Radiology Clerkship

35. Acknowledgements I would like to close by acknowledging our medical students who we are privileged to teach and whose comments and suggestions have helped us improve our clerkship curriculum and experience. - Amira Gohara, MD