for the Millennial Student Pathology Teaching for the Millennial Student

Dr. Amira Gohara Trained in pathology in Egypt and U.K. Came to Toledo in 1970 Resident Faculty member Chair of Pathology Dean of Medicine President of MCO Emeritus 2005 Developed pathology clinical curriculum Double Golden Apple recipient x 6 Outstanding Teaching Award, MCO Outstanding Teaching Award, UT Student hooder > 9 straight years

Class of 2015 13 UT students pursued pathology as a career Outcome Class of 2015 13 UT students pursued pathology as a career

Student’s Profile Most are junior AOA Most have Step 1 scores ≥ 250 The top graduating student joined the residency program at Emory University

Where Did They Go?

Clinical experience in pathology for University of Toledo students Currently we have seven electives in pathology, one during the foundational sciences period and six during the clinical years. They are very popular and very well received by the students. In 2015/2016, we had 522 rotations.

Number of clerks Year

What is Pathology in the mind of a medical student?

Pathology The pumping heart of Medicine VEINS ARTERIES Questions from clinicians regarding slides Lab tests Autopsy findings Diagnosis Lab test interpretation Clinicopathologic correlations on autopsies Consultant rounds with clinicians

Valves Managing utilization of lab tests Costs of tests

Central role of Pathology Internist Surgeon Radiologist Pathologist ER Doctor A Team! Kidney transplant

How can we get the message out to medical students regarding what pathologists do?

Travel with them through their 4 year medical school journey

1st Year Pathology Club Advisor Current Curriculum Lab Vignette Elective 2017 New Curriculum Longitudinal Foundational Science Years

New Curriculum (Integrated System Based Foundational Sciences 2nd Year Current Organ Systems Physiology Pharmacology Pathology Step 1 Strategy & Tutoring New Curriculum (Integrated System Based Foundational Sciences

Sophomore pathology (current) Lectures - Vignette based Questions related to vignette including: Lab tests Morphology CPC

Small group sessions - all vignette-based A 25-year-old man works in a military fuel depot. He began having respiratory difficulty along with red-tinged sputum. Two months later, he had increasing malaise and flank pain. He went to see the base physician. The patient then developed very rapid onset of renal failure with hematuria within three days. What tests and procedures would you order? What is the differential diagnosis? What additional laboratory tests can be ordered?

3rd Year Current 3rd Year Elective Clerkship Post-Sophomore Fellowship New Curriculum Laboratory Medicine/Pathology rotation as a graduation requirement Post-Sophomore Fellowship

4th Year Pathology Electives Case Studies Independent Study Pathology/Radiology Clerkship Pathology Clerkship Strategies for Step 2 CK LORs Mentoring Recruiting

Clinical clerkship: Radiology/Pathology

Pathology Clerkships (176 students) Partner each student with a resident or fellow mentor Mini-histology course on day 1 of rotation Use of the Simulation Center for hands-on experience in FNA and autopsy Practice frozen sections with Pathologist’s Assistant (autopsy tissues) Grossing, sign-out, and consensus conference Microbiology rounds with head technologist Scope time with Dr. Gohara: archival teaching slides Neuropathology time with Dr. Mrak: Gross neuropathology powerpoints Topic presentations. Examples: Wet prep Pathology of breast cancer Imaging in breast diseases HPV Non-pathologic variables that impact lab tests Custom-tailored special rotations: Dermatopathology Neuropathology Microbiology

Case Studies (176 students) 3 cases per day Interactive Discussion of diseases related to cases Step 2 CK prep

Independent Study (160 students) Literature search Summary paper

Who has the answers for Mr. Jones’ clinical dilemma? Seniors Who has the answers for Mr. Jones’ clinical dilemma? Let me go talk to Dr. Gohara…

Student evaluations of clinical clerkships in pathology Our current elective clinical clerkships are more highly rated than any current required core clerkship (average rating 3.84/4.0) often mentioned in our graduation questionnaire as one of the most valued experiences in the College of Medicine

2017: A new curriculum Interactive learning case/team orientated Flipped class room More small groups (8 students per group) and Team or group based learning

The new curriculum will include a 2-week, required Laboratory Med/Pathology clinical clerkship We proposed the creation of a 2-week, required laboratory medicine/pathology clerkship as a graduation requirement. This was approved by the Clinical Curriculum and Executive Curriculum Committee in 2016.

Approved Lab Medicine Pathology/Radiology Graduation Requirement The rotation will include: THE LABORATORY MEDICINE EXPERIENCE will include cost effective laboratory utilization, indications and interpretations of laboratory tests, as well as turnaround time. BASIC SURGICAL PATHOLOGY including frozen sections, grossing specimens and sign-out. CYTOPATHOLOGY AND FNA will be an integral part of the rotation. THE AUTOPSY EXPERIENCE will include how to discuss the need for an autopsy with the family, obtaining an autopsy permit, participating in a real cadaver autopsy at the Simulation Center and filling out the death certificate. CLINICAL GENOMICS EXPERIENCE is also included.

Pathology/Radiology Clerkship

Acknowledgements I would like to close by acknowledging our medical students who we are privileged to teach and whose comments and suggestions have helped us improve our clerkship curriculum and experience. - Amira Gohara, MD