2013 CURE Preclerkship Presentation Pathology education and its role in the CURE process

Outline • Mutual needs of pathology and medical education • Pathology goals for the curriculum renewal. • Pathways to realize these goals in the CURE process.

Wayne Gretzky

“A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be. -Wayne Gretzky”

Pathology Education (Preparing for Tommorrow) • Pathology as validation for the clinician’s role in healthcare. • Pathology in the era of personalized medicine. • Need for diagnostic communication

What is the future of our role as a physician?

What is our role as a physician? • … I doubt very much if

within 10-15 years…I won’t be able to ask Siri’s great great grandchild (Version 9.0?) for an opinion far more accurate than the one I get today from the average physician.

• Vinod Khosla

Pathology-A distinguishing component of physician education • A machine can do better statistics/data mining, but it doesn’t

have the inherent understanding of a physician. • A comprehensive and in-depth understanding of pathology

will serve as a quality control (or sanity check) in a new area of algorithmic medicine.

t(9;22) translocation ->Biology of disease (~1990)

t(9;22) translocation ->Pharmacology (~2000)

Today’s Pathology is Tomorrow's Pharmacology

Today’s Pathology is Tommorrow Pharmacology • Strong background in pathology is a solid investment in a

future learning curve of personalized medicine.

Are we prepared for the complexity? • 1940 Adult fibrosarcoma • 1980 Low grade fibromyxoid

sarcoma • 2005 Low grade fibromyxoid

sarcoma with t(7;16) translocation

• 2015? Low grade fibromyxoid sarcoma with t(7;16) translocation and favorable genomic profile (please consider such and such therapy)

(or rather) are we prepared for the communication? • Preclinical coursework does not facilitate postgraduate

interaction. • This cannot continue to slide with continuing complexity. • Medical students need to learn interaction:

• How to read a pathology report? • When to call a pathologist? • What to ask a pathologist?

Cytogenetics

Molecular studies

Flow cytometry

Correlation

Final Report

Adenocarcinoma?

An online survey of physicians outside of the laboratory by the College of American Pathology:

(Physicians) B1. How important are pathologists to your practice?/ B10. Do you have established professional relationships with individual pathologists? / B11. Overall, how satisfied are you with your working relationships with individual pathologists?/ B12. In general, how satisfied are you with the pathology services you receive?

94% believe pathologists are (very/somewhat) important to their practice

98% [of those with relationships] are (very/ somewhat) satisfied with their working relationships with individual pathologists

97% are (very/somewhat) satisfied with the pathology services they receive

66% have established professional relationships with pathologists

17

(on a four-point scale)

(on a four-point scale)

(on a four-point scale)

Usage of Pathology Services

(Most of the Time/Always)

Goals • Establish a (content) foundation

• Emphasis on particularly relevant models of disease. • Introduce a model of communication.

• Understand both the role of pathologists (and content).

Establishing a foundation

Establishing a foundation • Pathology… a daunting task… • How to cover 1400 pages?

Curriculum Advisory

What to teach/what not to teach? • Pathologists will be greatest resource for curriculum design

• Pathology NBME Presentation Materials • Graduate Research in Pathology Education (GRIPE)

• Can contact similar pathology subspecialists for input • Peer reviewed question bank (NBME style questions)

• Pathology labs (particularly dry labs) can supplement didactics. • Over course of year, specimen photographs can be obtained. • Polling software can increase participation.

Establishing Communication

Clinical Reasoning • Pathology presents opportunity for multimodality education. • Instead of talking about the biopsy results

• Allow the students to review gross/microscopic findings • Allow pathology faculty (and residents) to present their

interpretation. • Allow the students to inquire regarding the most important parts of

the report. • Eg Grade • Eg Margin status

• Allow the faculty/residents to review the pathology mechanism of disease.

Example 1 (less effective) • The tumor was resected and came back a liposarcoma. How

would you treat this?

Example 2 (more effective) • You (a surgeon) resect a large portion of the tumor and send

for an intraoperative consultation. • Grossly the tumor appears as follows…

Example 2 (more effective) • A section is taken for frozen section diagnosis. • Please review the gross and frozen section slide. • http://rosai.secondslide.com/sem575/sem575-case3.svs/

• Do you think this tumor is malignant. • What would your differential be? • What kind of information would you want from the pathologist? • What type of molecular studies could help confirm the diagnosis?

Benefits (win-win) • More interaction and emotional commitment from residents • Visual reinforcement of material and case • Begins to teach appropriate interaction and lab utilization

Conclusions • The CURE process offers an opportunity to preemptively

design for personalized medicine. • Pathology is critical for the process • Communication is critical for appropriate didactic content • Problem solving exercises offer new opportunities for

• Improved communication skills for diagnostics • Improved interaction with pathology material • Greater reinforcement of concepts of biology of disease.