For medical students, the future of pathology education is unfolding now
“Like a steam locomotive roaring down the tracks, the events of 2020 brought into clear focus the concept of change,” wrote Duke University pathologist Sarah Bean in “Change in Medical Education: the Time is Now,” an introduction to a special section of Archives in Pathology and Laboratory Medicine on medical education published in 2021. “The pandemic forced us to rapidly embrace change to use technology in medical education so that education could continue during the pandemic while allowing for physical distancing.”
What followed the pandemic was a surge in “distance learning” and “asynchronous learning,” the latter defined as “a general term used to describe forms of education, instruction, and learning that do not occur in the same place or at the same time.” Both are enabled by the computer, and both are transforming medical education.
When LMP assistant professor and hematopathologist Cade Arries became LMP’s Director of Medical Student Pathology Education in August last year, he was already at work developing an asynchronous histopathology learning resource for medical students, residents, and fellows. In March, he and LMP professor Michael Linden, Hematopathology Division Head, published “Enhancing hematopathology peripheral blood smear education through asynchronous video material: A pilot report” in Academic Pathology. The 28 brief videos are posted on the LMP YouTube channel here.
“While more research is required to further evaluate the long-term effectiveness and impact of asynchronous video learning, this study provides encouraging preliminary evidence supporting its potential as a valuable tool in enhancing medical education,” the authors wrote in the conclusion. “It is our hope that our work will inspire further development and application of such educational resources, thereby improving trainee education and ultimately patient care outcomes.”
Initiatives like the asynchronous video project and his skill at implementing the new pathology curriculum for first-year medical students earned Arries a Distinguished Foundational Science Teaching Award from the Medical School, which he received at the Dean's Tribute to Excellence in Education event at the Bell Museum in May. “That award was specifically granted thanks to the first group of medical students enrolled in the new curriculum,” Arries said in an interview. “One of the major changes that occurred in the curriculum in general was after COVID. We had to pivot. There was a lot that had to happen rather quickly.”
Perhaps the biggest change in the new curriculum is that students have access to the clinic sooner. “It’s not just our Medical School,” Arries said. “It’s the trend nationwide to reduce the pre-clinical time. There has been a nationwide desire of students to start their clinical experiences earlier. Some medical schools don’t have all the necessary resources to start earlier, but we do. So why not?”
Initially, the incoming first-year class under the new curriculum was to be introduced to clinical experience – in a hospital- or clinic-based interaction with patients -- as early as October. That was pushed back to January. “I think that the general reasoning for why the preclinical learning has been shortened is because the students are eager to enter into the medical practicing arena,” Arries said. That’s reflected in student feedback to the Liaison Committee on Medical Education (LCME), an accrediting body sponsored by the Association of American Medical Colleges (AAMC) and the American Medical Association (AMA). “Student feedback and satisfaction carries a lot of weight with accreditation bodies,” he said. “In fact, it was one of the reasons that the Medical School ultimately decided to update the curriculum with a focus on student needs and national trends.”
Another major change in the curriculum is the shift to an organ-systems based approach to learning that integrates traditional disciplines such as anatomy, physiology, and histology. “We haven’t really developed a ton of the content for this approach in the time constraints of the new condensed curriculum,” Arries said. “We’re kind of building the train as we’re riding it.”
Arries found that it was hard to know what exactly he was supposed to cover in his first course and how he could build on what he taught and apply it to future courses. “In this next iteration, it’s beginning to make a little more sense,” he said. “I know now what sessions I have allocated to me in future organ-based courses. The amount of time allocated to pathology concepts does change course to course, which has been challenging. But at least I’m able to think about these principles – what used to be called principles of pathology -- and kind of build on those concepts again and again for each future course.”
Digital pathology (DP) is making its way into the pathology curriculum as well as clinical practice. “The incorporation of DP into the curriculum has been cited as being user-friendly and advantageous because of the ease of accessibility globally,” wrote the authors of “Pathology Education Powered by Virtual and Digital Transformation: Now and the Future” published last year. They reported that it leads to improvement in academic performance based on test scores and greater student satisfaction and engagement.
Now artificial intelligence (AI) and machine learning are coming into play. The recently awarded Nobel Prizes in chemistry (protein folding and protein design), physics (neural networks), and economics (labor and automation) all involve AI.
“That’s one of the things the students are asking about,” Arries said. “One of the first things they ask is, ‘How is AI going to affect the field of pathology?’ We don’t know. I’m curious myself to know how it will affect the field.”
Arries said he’s working with some medical students on creating and evaluating a pilot AI training session for first-year University medical students. He emphasized that the training session will be developed from a student perspective.
“I’ve learned that most of the students entering medical school haven't used large language models (LLMs),” Arries said. “They’re part of a generation that, when ChatGPT came out, they were undergrads. The attitude from instructors was ‘You cannot use this. It is intellectual dishonesty if you use it.’ Whereas in a few class years from now, we’re going to see some students who started using it in high school. They’ll be less taboo about it and more competent about using AI. The next question will be ‘How do we imagine the role of physicians practicing in the future where AI is as commonplace as Internet resources are today?’”
