JOURNAL OF PATHOLOGY, VOL.
167: 173-1 74 (1992)
EDITORIAL PATHOLOGY IN THE UNDERGRADUATE MEDICAL CURRICULUM
Medical schools recruit the brightest of school leavers. They enter university with enthusiasm. Pathology is one of the most exciting subjects that they could study. Yet many students, perhaps more in some medical schools than in others, perceive it as boring and irrelevant. This is a savage indictment of those who teach pathology. Teaching of pathology should be subsumed in some form of cross-departmental ‘medical educational institute’, organized within the Faculty of Medicine by people with special interest and qualifications in medical education. The organizers must be accountable for its quality. The ‘gentleman amateur’ approach by which medical education is undertaken as a sideline to research and service work is inimical to high quality: pathologists who teach must be properly trained and qualified. Given this framework, how should students be nurtured in pathology? All courses have aims and objectives.’ It is essential that these be written down as explicitly as possible, discussed and agreed widely, and circulated to all students and staff concerned in the course. Without a formal document, course participants concoct their own, variable, unwritten list of aims and objectives. The document should act as a contract between examiners and candidates: the examiners will guarantee that nothing outside it will appear in examinations, but the candidates must not expect to receive formal teaching on every topic. This avoids the difficulties created for students by examiners with a hidden agenc‘a ofsecret objectives. Such a list obviates the need for students to attend lectures in order to find out the course aims and objectives. Lectures can thus be viewed as only one of many teaching methods, not as the basis of the course. Many lectures could be abolished and replaced by more interactive methods, including small group teaching. There is now a welcome trend towards self-access techniques, such as computer-assisted learning and 0022-34 17/92/060 I 73-02 $06.00 0 1992 by John Wiley & Sons, Ltd.
interactive videodisc.2 This reduces the student’s dependence on teaching of variable quality. The written list of aims and objectives is, however, particularly important as a guide. The latter two methods are combined in problembased learning,j in which small groups of students, with the aid of a tutor, formulate and solve a crossdisciplinary problem. Problem-based learning is likely to find increasing use in the future, but entails proper staff training and is not an easy option to traditional teaching methods. The potential value of practical work is not in dispute; the classes are. How valuable is practical microscopy to students? With high-quality microscopes, good sections. and imaginative teaching, microscopy may be of value. Much of it is, unfortunately, perceived by students as tedious. After a year of classes, many students could not recognize a polymorph if it waved a pseudopodium at them. There are, of course, valuable side-effects, such as the opportunity to chat to pathologists, but these might be achievable in other fora. Research is required to determine the effectiveness of practical microscopy in student learning of pathology. Plastination may offer a more vivid way of demonstrating naked eye material than museum pots.4 Lack of funding and adequate safety standards may preclude individual departments from plastinating specimens but perhaps resources could be pooled. What role should the autopsy play in teaching? Some students find the post-mortem room distasteful,’ and more research to determine the optimum forum for demonstrating disease in the flesh would be worthwhile. Perhaps interested students could undertake optional studies in autopsy work. Video is useful for presenting autopsy material, especially to large audiences.‘ Assessment methods are often based more on tradition rather than on educational criteria determined by course objectives. If recognition skill, such
174
EDITORIAL
as in practical microscopy, is not an objective, then it should not be tested. Short-answer questions are valuable but long-essay questions, although useful in project work, are unreliable in examinations, because of variation in marking. With multiplechoice questions, stored with related statistical information on a computer database, it would be feasible to construct an inter-university bank of high quality questions sufficiently large to allow students access. Feedback from staff and students is, of course, essential. All marks, papers, etc. should be returned to candidates and discussed as required. Regrettably, some institutions still forbid this, calling into question the reliability and validity of their assessment methods. Evaluation of courses, too, will become more professional. Questionnaire design, for example, requires considerable skill, so that it yields useful information about the course without threatening staff members. There is a great need for pathologists to undertake more educational research. This could lead to more explicit national guidelines on undergraduate
pathology course aims and objectives, teaching methods, assessment and evaluation procedures. Cherished activities which cannot be educationally justified may be unceremoniously removed from the medical curriculum. W. A. REID Department of Pathology University of Leeds Leeds LS2 9JT, U.K.
REFERENCES I. Newble D, Cannon R. A Handbook for Medical Teachers. 2nd ed. Lancaster: MTP Press, 1990: 71-79. 2. Mercer J, Pringle JH, Rae MJL, Harkin PJR, Lauder I. The laser videodisc and computer-assisted learning. J Pathol1988; 156 83-89. 3. Bosman FT, Arends JW. Teaching pathology in a problem-orientated curriculum: the Maastricht experience. I Puthot 1989; 159: 175-178. 4. Von Hagens G, Tiedemann K, Kriz W. The current potential of plastmation. Anal Embryo/ 1987; 175 41 1 4 2 1 . 5. Benbow EW. Medical students’ views on necropsies. J Clin Pafhol 1990; 43: 969-976. 6. Goudie RB, Harris P, Patterson W. Post-mortems by video. J Pathol 1988; 154: 195-197.
167: 173-1 74 (1992)
EDITORIAL PATHOLOGY IN THE UNDERGRADUATE MEDICAL CURRICULUM
Medical schools recruit the brightest of school leavers. They enter university with enthusiasm. Pathology is one of the most exciting subjects that they could study. Yet many students, perhaps more in some medical schools than in others, perceive it as boring and irrelevant. This is a savage indictment of those who teach pathology. Teaching of pathology should be subsumed in some form of cross-departmental ‘medical educational institute’, organized within the Faculty of Medicine by people with special interest and qualifications in medical education. The organizers must be accountable for its quality. The ‘gentleman amateur’ approach by which medical education is undertaken as a sideline to research and service work is inimical to high quality: pathologists who teach must be properly trained and qualified. Given this framework, how should students be nurtured in pathology? All courses have aims and objectives.’ It is essential that these be written down as explicitly as possible, discussed and agreed widely, and circulated to all students and staff concerned in the course. Without a formal document, course participants concoct their own, variable, unwritten list of aims and objectives. The document should act as a contract between examiners and candidates: the examiners will guarantee that nothing outside it will appear in examinations, but the candidates must not expect to receive formal teaching on every topic. This avoids the difficulties created for students by examiners with a hidden agenc‘a ofsecret objectives. Such a list obviates the need for students to attend lectures in order to find out the course aims and objectives. Lectures can thus be viewed as only one of many teaching methods, not as the basis of the course. Many lectures could be abolished and replaced by more interactive methods, including small group teaching. There is now a welcome trend towards self-access techniques, such as computer-assisted learning and 0022-34 17/92/060 I 73-02 $06.00 0 1992 by John Wiley & Sons, Ltd.
interactive videodisc.2 This reduces the student’s dependence on teaching of variable quality. The written list of aims and objectives is, however, particularly important as a guide. The latter two methods are combined in problembased learning,j in which small groups of students, with the aid of a tutor, formulate and solve a crossdisciplinary problem. Problem-based learning is likely to find increasing use in the future, but entails proper staff training and is not an easy option to traditional teaching methods. The potential value of practical work is not in dispute; the classes are. How valuable is practical microscopy to students? With high-quality microscopes, good sections. and imaginative teaching, microscopy may be of value. Much of it is, unfortunately, perceived by students as tedious. After a year of classes, many students could not recognize a polymorph if it waved a pseudopodium at them. There are, of course, valuable side-effects, such as the opportunity to chat to pathologists, but these might be achievable in other fora. Research is required to determine the effectiveness of practical microscopy in student learning of pathology. Plastination may offer a more vivid way of demonstrating naked eye material than museum pots.4 Lack of funding and adequate safety standards may preclude individual departments from plastinating specimens but perhaps resources could be pooled. What role should the autopsy play in teaching? Some students find the post-mortem room distasteful,’ and more research to determine the optimum forum for demonstrating disease in the flesh would be worthwhile. Perhaps interested students could undertake optional studies in autopsy work. Video is useful for presenting autopsy material, especially to large audiences.‘ Assessment methods are often based more on tradition rather than on educational criteria determined by course objectives. If recognition skill, such
174
EDITORIAL
as in practical microscopy, is not an objective, then it should not be tested. Short-answer questions are valuable but long-essay questions, although useful in project work, are unreliable in examinations, because of variation in marking. With multiplechoice questions, stored with related statistical information on a computer database, it would be feasible to construct an inter-university bank of high quality questions sufficiently large to allow students access. Feedback from staff and students is, of course, essential. All marks, papers, etc. should be returned to candidates and discussed as required. Regrettably, some institutions still forbid this, calling into question the reliability and validity of their assessment methods. Evaluation of courses, too, will become more professional. Questionnaire design, for example, requires considerable skill, so that it yields useful information about the course without threatening staff members. There is a great need for pathologists to undertake more educational research. This could lead to more explicit national guidelines on undergraduate
pathology course aims and objectives, teaching methods, assessment and evaluation procedures. Cherished activities which cannot be educationally justified may be unceremoniously removed from the medical curriculum. W. A. REID Department of Pathology University of Leeds Leeds LS2 9JT, U.K.
REFERENCES I. Newble D, Cannon R. A Handbook for Medical Teachers. 2nd ed. Lancaster: MTP Press, 1990: 71-79. 2. Mercer J, Pringle JH, Rae MJL, Harkin PJR, Lauder I. The laser videodisc and computer-assisted learning. J Pathol1988; 156 83-89. 3. Bosman FT, Arends JW. Teaching pathology in a problem-orientated curriculum: the Maastricht experience. I Puthot 1989; 159: 175-178. 4. Von Hagens G, Tiedemann K, Kriz W. The current potential of plastmation. Anal Embryo/ 1987; 175 41 1 4 2 1 . 5. Benbow EW. Medical students’ views on necropsies. J Clin Pafhol 1990; 43: 969-976. 6. Goudie RB, Harris P, Patterson W. Post-mortems by video. J Pathol 1988; 154: 195-197.
