Pathology Education: Moving On
Donald Earl Henson, Philip M. Grimley · Archives of Pathology & Laboratory Medicine · 2015
The study of human disease has led to new discoveries and insights, resulting in improved patient care. Early scientific inquiries were inspired by the observations of anatomists, who noted morphologic deviations from normal in postmortem dissections.1 Once morbid anatomy was found to correlate with specific functional disturbances in the living body, modern anatomic pathology and physiology appeared on the horizon.2During the 19th century, technical improvements in optics and introduction of the compound microscope accelerated the advancement of basic biologic knowledge, and microscopic observations of diseased tissues revolutionized the scientific approach to medicine.3 Thus, Virchow postulated that the fundamental manifestations of disease were the results of alterations at the cellular level.4 This seminal concept led to improved classification of disease, stimulated testable research hypotheses, and engendered novel concepts of pathogenesis.During the 20th century, refined observations of cell structural details, including new staining techniques and electron microscopy, began to reveal specific subcellular changes associated with disease. As increased knowledge of cell biology and immunology percolated into clinical practice, pathologists were able to incorporate diagnostic immunochemical or immunologic labels as biomarkers to confirm disease classification and guide treatment. Classical radiology progressed to encompass the dynamic imaging techniques of radionucleotide tracing, electromagnetic tomography, and ultrasonography. Combined with classical tissue examination, these dynamic imaging technologies vastly extended the boundaries of medical observation.In the 21st century, biotechnology is moving on in many new directions. As multidimensional anatomic, radiographic, ultrasonographic, and subcellular observations of disease permeate the medical sciences, patient care also is being influenced by advances in bioinformatics, bioengineering, molecular biology, and molecular genetics. With the advent of genomic medicine5–7 and rapid microsampling of tissues or fluids,8,9 the focus of medical practice is moving toward data analysis. Even though future advances in medical care and translational research will not necessarily be tethered to traditional morphology, a physician's understanding of disease remains rooted in visual observations tandem to clinical history and physical examination.Clearly, the classical pathology component in medical education is one of visual experiences relevant to the principles of pathophysiology that underlie disease manifestations, progression, and natural history. The ongoing challenge is to optimize the instructional value of morphologic observations at all levels of available analysis in the context of new technologies. What visual elements of morphology will now best serve future physicians as they evaluate differential diagnoses or elect therapeutic options? The contribution of traditional observational studies and knowledge retention in a world of increasingly complex biotechnology and genomics needs thoughtful reexamination. Similar efforts are brewing in the field of radiology.10–12A new canon of medical teaching already calls for a systematic integration of course materials and emphasizes early clinical exposure with coordinated group discussions and case presentations.13–16 This represents a significant advance in medical education, but a sequential layering of case data, pathology images, and radiologic imaging may not go far enough to create coherent preclinical impressions of disease. We propose that preclinical education move on toward a synchronous convergence of instruction that includes more vivid correlations of pathologic anatomy and imaging technologies. The aim is to encourage more holistic student conceptualizations of major disease processes. Indeed, contemporary studies of visual memory and cognition suggest that convergent sensory stimulations can serve to facilitate information retention.17Obviously, the impact of convergent instruction in the observational sciences of medicine will ultimately depend on knowledgeable and committed instructors who prepare to capture student attention through cogent presentations. To this end, pathologists and radiologists should cooperate more closely to hone student development of the critical observational skills essential to clinical problem solving. Both specialties would benefit. Both disciplines represent disease in images. Both focus on the establishment of appropriate diagnoses that underlie the evaluation of potential outcome and choices of therapy. We emphasize that image integration based in pathology and radiology should occur concurrently with convergent images specifically selected to highlight pathogenesis and natural history. In addition to conceptual value, students can immediately appreciate the mutually supportive diagnostic roles of pathology and radiographic imaging at the onset of their medical careers. Positive educational experiences should foster lasting enthusiasm and reinforce emergent student interests in the observational sciences and what these sciences can offer as pathology education moves on.