EDUCATION
Grover F. Powers, M.D., Contributing Editor
A
PLAN
FOR
CORRELATED
TEACHING
OF
BASIC
PEDIATRIC
PATHOLOGY
DURING
PEDIATRIC
CLINICAL
CLERKSHIPS
By Tyree C. Wyatt, M.D., and William D. Alsever, M.D.
Department of Pediatrics, State University of New York Upstate Medical Center, Syracuse, and Departments of Pediatrics and Pathology, Syracuse Memorial Hospital
ADDRESS: (T.C.W.) Syracuse Memorial Hospital, Syracuse 10, New York.
301
CONTRIBUTORS’ SECTION
T
HIS is a report of the plan for teachingbasic pediatric pathology in connection
with ward teaching during clinical
clerk-ships, which has been in use for several
years in the Pediatric Department of the
State University of New York at Syracuse.
Its success as one of the most practical ways
of drawing the preclinical basic sciences
closer to actual patient care may be of
in-terest to teachers, either in pathology or on
the wards, who feel that there is still too
wide a gap between the preclinical years
and the clinical teaching years. This
prob-lem has been one of long recognition and
concern, varying in degree and intensity in
different settings dependent in a large
measure on the background in basic science
training and experience of the clinical
teachers.
It would also appear that with the
in-creased emphasis which is quite properly
being placed on the teaching of the
psycho-logic and sociologic aspects of patients’
problems, the curriculum should continue
to provide ample time in both the
pre-clinical and clinical years for the student to
keep a properly balanced perspective
be-tween organic and functional problems, as
they may occur separately or in
combina-tion.
Also, paradoxically, with the great
ad-vances in medical information through
laboratory studies and the increasing
de-pendence of the clinician on the laboratory
for accurate diagnoses and confirmatory
support of the clinical diagnoses, there ap-pears to be considerable reluctance on the part of the average student, undergraduate
as vell as graduate, to personally pursue even the simplest and most elemental laboratory studies. One of the best antidotes
for this lethargic willingness to wait for the
routine laboratory reports to come from
others is the stimulating effect of a clear understanding of the suspected basic
pa-thologv in the patient. Such understanding
should lead to a desire to personally ex-amine in tile laboratory, without great time involved, such specimens as may throw ligilt on the pathology. The student’s
suspicions might of course be in error and
complicated laboratory investigations by
other hands might be needed, but at least tilere has been a thoughtful approach
toward the patient’s possible organic
prob-lem and something has been learned even if
ill a negative way. A prerequisite for
effec-tive fulfillment of this kind of inquisitive
initiative on the part of clinical clerk or
house officer is having a clinical laboratory very near the ward.
HISTORICAL NOTE ON THE USE OF
HISTOPATHOLOGIC LOAN
COLLEC-TIONS IN THE TEACHING OF
PATHOLOGY
In 1914 Steensland and Weiskotten’ in
the Department of Pathology at Syracuse
lend-302 WYATT - PLAN FOR TEACHING PEDIATRIC PATHOLOGY
ing students in pathology a loan collection
of previously prepared sections showing
the major pathologic processes. This idea
was a radical change from the almost
uni-versal method of having students
labori-ously prepare and stain a limited number
of sections during the time allotted in the
curriculum to pathology. The advantages of
having available for the student a much
larger and better prepared collection for
use in the limited time for study was
recog-nized and the use of a loan collection was
adopted by the Departments of Pathology
in all medical schools. The present paper
some 40 years later from a clinical
depart-ment in the same school (with different
University affiliation) describes the use of
a “specialized” Histopathologic Loan
Col-lection in connection with the clinical
teach-ing of pediatrics.
MATERIALS
The Loan Collection of microscopic
ma-terial now consists of just over 100 slides;
about 80 of which are tissue sections and
about 20 of which are hematologic
prepara-tions of peripheral blood and bone marrow.
Although the present size of the Loan
Col-lection is a convenient one using a standard
100-slide box, it is anticipated that it will
be increased as new and better material
becomes available. At present there are
obvious omissions in certain fields of
pedi-atric pathology and hematology which are
gradually being filled in. The slides are
arranged in these groups:
(1) Diseases of the Lungs, beginning
with tile premature and newborn problems.
(2) Diseases of the Cardiovascular
Sys-tern, including rheumatic fever.
(3) Miscellaneous Diseases and
Infec-tions, including tuberculosis.
(4) Diseases of the Kidneys.
(5) Diseases of the Gastrointestinal
Tract, Liver, and Spleen.
(6) Diseases of the Central Nervous
System.
(7) Neoplastic Diseases.
(8) Diseases of the Blood and
Blood-assigned to each pair of students for the
6 weeks clerkship. A deposit is required
from which deduction is made for breakage
and shortages at the time of return.
A loose-leaf syllabus of slightly over 100
pages is given each clinical clerk for
per-manent possession and incorporation of
such notes as he may make during the
clerkship. The context of the syllabus
ma-terial referring to individual slides or groups
of slides is arranged in general as follows:
(1) A brief statement of the important
clinical features of the patient who was the
source of the material to be studied.
(2) Suitable prints of roentgenograrns
showing striking gross pathology.
(3) A statement of the gross necropsy
findings and the location of such gross
speci-mens as are available from the patient or
similar patients.
(4) In order to conserve the student’s
time, a brief description of what the student
should readily see in the microscopic
sec-tions in the way of general architectural
and detailed cellular changes.
(5) Comment on the combined
clinical-radiologic-pathologic aspects of the case
and the general deductions and lessons to
be learned.
METHODS OF TEACHING AND USE
OF MATERIALS
Although the group of 12 Junior-year
clinical clerks are assigned for their
pa-tient care in two separate hospitals for 6
weeks, it is possible to have both groups
together for 13 hours each Wednesday
morning at the Syracuse Memorial Hospital
which is the central unit of the Pediatric
Department and the Pediatric Pathology
Laboratory. In preparation for this
Wednes-day conference one of the authors usually makes ward rounds on the preceding day
throughout the year. These rounds not only
serve as preparation for the students’
path-ology conference but also the very useful
purpose of keeping the Pediatric Pathology
Department in close touch weekly with the
EDUCATION 303
day conference a record is given the
in-structor by each student of the working
diagnoses of patients currently assigned to
him. Using this list together with personal
ward round familiarity with at least some
of the patients, the instructor is able to
co-ordinate the use of the material in the
Loan Collection and syllabus with the
pa-tients currently being studied on the wards
by a given student.
A block of 15 to 20 slides and the related
syllabus material is assigned for study
each week. Each student is expected to be
well enough prepared on this assignment to discuss, with pointer in hand, any section
which the instructor may select and project
to the screen. During this microprojection
and discussion the student is encouraged to
use concise and appropriate terminology in
describing the pathological changes which
he observes, his interpretation of these
changes, and finally his correlation of the
changes to clinical and therapeutic aspects
of the problem.
In addition to this block assignment each
week, each student is expected to be
thor-oughly familiar with material related to any
current patient presumed to have such
pathological changes. In this way the
pa-thology of the common pediatric problems is discussed in terms of patients currently
on the wards. This discussion of patients
under observation at the time, and their
suspected pathology in terms of specimens
and sections which the student has
avail-able for study, gives him a well-rounded
viewpoint as to diagnosis and therapy.
Students in general meet satisfactorily
these exacting weekly assignments and are
well enough prepared so that at times the
instructor can digress and discuss related
clinical and pathologic material. To
stim-ulate weekly systematic preparation,
20-minute quizzes of one question are often
given without previous announcement. The
students’ response to this kind of teaching
exercise, which involves considerable effort
on their part, has been gratifying and
re-quests have often been made that time be
found for 2 such conferences each week.
COMMENT
As is stated in the introduction to the syllabus, there is no desire to give another
course in pathology or even one limited to
the problems peculiar to infants and
chil-dren. The plan offers, however, an
oppor-tunity to review the basic pathologic states as they are frequently modified in
various stages of growth, development, and
nutritional changes. Furthermore, it offers
an opportunity in the teaching of “applied pathology” together with clinical, radiologic,
and laboratory studies of actual patients.
An obvious secondary benefit from such
a plan lies in the fact that it offers each
clinical clerk an opportunity to round out
and enlarge his clerkship experience through the review and study of many
pediatric problems which are not likely to
be represented by patients in all periods of
clerkship.
Although the syllabus and Loan
Collec-tion were planned and have been used primarily for teaching the undergraduate
inpatient clinical clerks of the Junior year,
they are also available for use by the
rotat-ing interns and residents in the Pediatric
Department. The assistant residents are
re-quired to study the material as their first#{149}
assignment when they rotate through the
pediatric pathology and hematology
lab-oratories.
While as yet this material has not been
used for postgraduate review there has been some indication that occasionally phy-sicians taking postgraduate work for suffi-cient periods of time might wish to combine a systematic study of the pathologic
ma-terial in connection with informal
confer-ences based on patients observed on the
wards.
REFERENCE
1. Steensland, H. S., and Weiskotten, H. G.:
The histopathologic loan collection and relieving the curriculum. J.A.M.A., 62:
