1. Medical education in pathology
Carlos Lopes, MD, PhD
Department of Pathology and Molecular Immunology of ICBAS – UP
Service of Pathology of CHP – Hospital de Santo António

2. Medicine today MULTIDISCIPLINARITY
Knowledge of multiple and different disciplines, integrated into a common thinking, that determine the nature and quality of medical actions (not just physicians) for the satisfactory solution of health problems and diseases of persons, families and communities

3. Multidisciplinarity
Is not an arithmetic or mathematical sum of different knowledge
is an intelligent and creative integration of knowledge from various sources, in which the resultant is greater than the sum and, above all, has more quality than a simple addition

4. Independent knowledge

5. SUM OF KNOWLEDGE

6. INTEGRATE MULTIDISCIPLINAR
KNOWLEDGE

7. multidisciplinarity
The practice of multidisciplinarity is one of the requirements of medicine in our days and in all specialities:
Oncology
Chronic inflammatory diseases
Infectious diseases
Metabolic diseases
Degenerative diseases
Genetic diseases
Diseases associated to development
Diseases associated to age
Every kind of diseases including emergent pathology

8. Integrated Multidisciplinarity
Each one, in his discipline (speciality), must be the best in knowledge, attitudes and do, in order to be specialist of high quality
Each one must have, from other specialities, knowledge and know-how needed to use them in his profissional activity, as specialist of high quality.

9. Medical education in anatomic pathology
Teaching
They are not same thing
Learning

10. The UROLOGIST: what must he know in pathology
The UROLOGIST: what must he know in pathology? The importance of a good selection of what must be teached
Urologic oncology – prostate, urinary bladder, kidney, testis, penis. Age in urologic oncology: neoplasias in children and adults.
Nefropathology – chronic nephropaties: vascular, glomerular, tubular, interstitial. Obstructive pathology
Renal transplant
Congenital diseases

11. General objectives of medical education
In the end of studies, the resident of urology has capacity to, in which concerns pathology,
Ask for histological reports, knowing depthly and exactly all data about which he wants to be informed (and not by simple mechanic ou routine acticity)
Fill carefully the form to ask histologic examinations, providing necessary clinical, analytical, image and other information, so that observation of histological slides can be well influenced by this knowledge
Know the adequate procedures to take out biopsy and surgical specimens, assuring for each of them good conditions of fixation, conservation and transport to the laboratory and preventing all kinds of artifacts due to crushing, small containers or bad conditions of fixation

12. General objectives of education
Communicate frequently with the pathologist
Know how to read and how to interpret an histological report
Contact the pathologist, to discuss with him all doubts and discrepancies found in the report, preventing subjective and personal interpretations

13. General objectives of education
To promote and to participate in clinico-pathological meetings for discussion of cases, therapeutic decision and continuous medical education
To know and be able to identify, the most important gross and histological alterations seen in important and common diseases,
To understand the virtuosities and limitations of anatomic pathology in diagnosis, taking in account the representativity of specimens
To participate in research:
To publish, at least, two papers (case-report , clinico-pathological series, groups of cases from the service)
To present, at least, four communications (oral or poster) containing cases and clinicopathological correlations.

14. Modalities of education
Programmed and organized courses
Training stages in pathology departments from one to three months
Continuous education

15. Modalities of education
Programmed and onganized courses
Formal courses organized by Urology and Pathology Colleges of Ordem dos Médicos
2 annual courses of 2 or 3 days each one (8 hours/day, 1 UC)
The resident must to participate and be approved , at least, in 6 different courses
Budget for travell and accomodation must be obtained from Ordem dos Médicos. Budget to prepare documents to be used in the course must be obtained from involved services of urology and pathology
In the end of each course the residents will have an evaluation.
“The student studies as you inspect and no as you expect”
Training stages in pathology services seems no to be a good solution

16. Modalities of education
Continuous education
Preparation of clinical cases to be discussed in the hospital and eventually to be selected for presentation in scientific meetings
Active participation in consultations of therapeutic decision
Presentation of bibliographic reviews.
Journal Club sessions
Education by internet, with emphasis for e-learning systems that include also evaluation

17. Module 1 – Neoplasias of urinary bladder. Introdution
How to fill forms to ask for histologic examination
Filling paper forms and electronic forms
Communication of clinical, image and analytical information
What is expected from pathology and time of answer
Containers and fixatives. How to accommodate specimens
The transport of the specimen to the laboratory
Procedures with urine, small biopsies, RTU specimens and surgical specimens
The refer of products
Frozen sections in bladder pathology

18. Module 2 – Neoplasias of urinary bladder
Urothelium in development of urinary bladder neoplasias.
Neoplasias of urinary bladder: epithelial and non epithelial
Classification and grade
Problems and difficulties. “Pit-fall”
Handling products in urinary bladder neoplasias
Urine and vesical watch
Small biopsies
Vesical TURs
Partial and total cystectomy
Flat and papillary lesions of urothelium
Reactive and neoplastic lesions

19. Module 3 – Neoplasias of bladder
Benign urothelial lesions: the papilloma problem
Low malignant potential urothelial neoplasias: questions of diagnosis and classification. Urothelial carcinomas: grade and behavior. Doubts and certitudes. Criteria for classification.
Quality of available specimens: how it can influence the quality of histological report
Immunocytochemestry and genetic in diagnosis and classification of urothelial carcinomas.
pTNM in bladder carcinomas
Urine cytology in bladder cancer

20. Module 4 – Neoplasias of bladder
Urothelial lesions induced by therapy
Differential diagnosis difficulties between neoplasia and lesion induced by BCG or chemotherapy.
Sarcomas, lymphomas and other type of urinary bladder neoplasias
Pseudo-tumoral lesions of bladder
Impact of molecular pathology in bladder neoplasias
Bladder neoplasias of children and young
Infections of bladder
Geographic pathology in urinary bladder

21. Medical education of residents in urology
In conclusion::
Identification of pathologists “sub- specialized” in urologic pathology by the College of Pathology
Elaboration of program of medical education by a mixed commission including specialists in pathology and urology.
Realization of the courses
Critical evaluation of results