Pam Harrison

November 03, 2015

Undergraduate medical students who perform cadaver biopsies develop a better understanding of pathology and might be enticed to join the field, according to an analysis of a pathology-based grand rounds program.

The program covers the entire pathology process, from "picking out a specimen, deciding to biopsy it, getting the cut, making a slide, and then analyzing it," said Jonathan Lavezo, MD, a first-year pathology resident at Stanford University in California.

It teaches you what to do with your pathology report when you get it back for a tumor resection, or something else," he told Medscape Medical News.

The study was presented at the American Society for Clinical Pathology 2015 Annual Meeting in Long Beach, California.

First-year medical students at the Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, in El Paso, are required to take the new cadaveric biopsy program, known as Tankside Grand Rounds.

"It's up to the students to create a picture of what life might have looked like for this patient and to deliver this perception during their presentations," Dr Lavezo explained. Students also have to deliver a formal case presentation on the premortem clinical course and suspected cause of death of the cadaver.

"It's done in the context of an anatomy course, so students are learning about anatomy," he added.

Hands-on Learning

To assess the benefit of the cadaveric biopsies, Dr Lavezo asked fourth-year medical students who had participated in the grand rounds program during their first year to complete a 15-question survey. They were questioned about their degree of involvement in pathology, the perceived benefits of early exposure to hands-on anatomic learning, and whether the experience affected their interest in pathology. At the time, Dr Lavezo was a fourth-year medical student in El Paso.

Of the 44 respondents, 77% agreed that their experience with cadaver biopsies had improved their understanding of pathology, and 73% indicated that the biopsy experience helped them to learn clinical connections.

In addition, 60% reported that the novel anatomic training increased their interest in pathology and laboratory results during their third-year clerkship.

"Because students sit down with the pathology faculty and go over these biopsies during their early medical school education, it closes the gap between the clinical side and the lab side, and brings clinicians and pathologists closer together," said Dr Lavezo. "Virtually all students — 98% — agreed that this activity should continue in future years."

Best of all, almost one-quarter of the students involved in the grand rounds program said the cadaver lessons had piqued their interest in a residency in pathology.

Recent data from the National Resident Matching Program indicate that more pathology residence positions go unfilled than almost all other specialties.

In 2014, for example, 31 pathology residencies remained unfilled; this was exceeded only by family medicine. And in 2015, 24 pathology residencies remained unfilled.

"These findings suggest that the cadaver biopsy experience increased student interest in pathology and lab results," said Dr Lavezo. "It gets back to the concept that this experience will potentially inform students about pathology and the benefits that pathology brings to patient care."

"If surgeons and clinicians understand what pathology can do to help their patients, it might not make everyone want to be a pathologist, but it will have some impact on us as doctors and help us provide better patient care in the long-run," he concluded.

Huge Hit With Students

For the past 3 years, Francis Gannon, MD, professor of pathology and orthopedic medicine at the Baylor College of Medicine in Houston, and his colleague Jerry Goodman, MD, a pathologist and associate dean of medicine at Baylor, have taught first-year medical students about the correlation between anatomy and pathology as revealed by specimens biopsied from cadavers.

"Students will present what they know about the clinical history from the cadaver, and then I'll show them the pathology that was taken from the liver or the lung, for example," Dr Gannon told Medscape Medical News. "We'll then go over the normal histology of the liver or the lung, and I'll show the biopsies that we've taken and allow for questions."

"It's a huge hit with the students," he explained.

Pathologists are not hidden in the dark in some basement.

The anatomic cadaver is the medical student's first patient, he pointed out. They learn not only what normal anatomy is, but also the pathology from which these patients died.

"This gets them thinking about the clinical application of pathology. Because I'm a physician, I am able to ask clinical questions and the students begin to see that pathologists are not hidden in the dark in some basement, but that we actually like patient care and that we have a lot to offer," Dr Gannon said.

He said he believes that Baylor's hands-on approach to teaching medical students has prompted more students to consider pathology as a specialty when they graduate.

"We have seen a direct impact from this kind of teaching on students," Dr Gannon reported. "Students realize that there is a clinical application to everything that they are learning about pathology."

Dr Lavezo and Dr Gannon have disclosed no relevant financial relationships.

American Society for Clinical Pathology (ASCP) 2015 Annual Meeting. Presented October 29, 2015.

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