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PubMed2005

Pathology reporting of breast cancer: trends in 1989-1999, following the introduction of mammographic screening in Western Australia.

BACKGROUND: A survey of pathology reporting of breast cancer in Western Australia in 1989 highlighted the need for improvement. The current study documents (1) changes in pathology reporting from 1989 to 1999 and (2) changes in patterns of histopathological prognostic indicators for breast cancer following introduction of mammographic screening in 1989. METHODS: Data concerning all breast cancer cases reported in Western Australia in 1989, 1994 and 1999 were retrieved using the State Cancer Registry, Hospital Morbidity data system, and pathology laboratory records. RESULTS: Pathology reports improved in quality during the decade surveyed. For invasive carcinoma, tumour size was not recorded in 1.2% of pathology reports in 1999 compared with 16.1% in 1989 (p<0.001). Corresponding figures for other prognostic factors were: tumour grade 3.3% and 51.6% (p<0.001), tumour type 0.2% and 4.1% (p<0.001), vascular invasion 3.7% and 70.9% (p<0.001), and lymph node status 1.9% and 4.5% (p = 0.023). In 1999, 5.9% of reports were not in a synoptic/checklist format, whereas all reports were descriptive in 1989 (p<0.001). For the population as a whole, the proportion of invasive carcinomas <1 cm was 20.9% in 1999 compared with 14.5% in 1989 (p<0.001); for tumours <2 cm the corresponding figures were 65.4% and 59.7% (p = 0.013). In 1999, 30.5% of tumours were histologically well-differentiated compared with 10.6% in 1989 (p<0.001), and 61.7% were lymph node negative in 1999 compared with 57.1% in 1989 (p = 0.006). Pure ductal carcinoma in situ (DCIS) constituted 10.9% and 7.9% of total cases of breast carcinoma in 1999 and 1989, respectively (p = 0.01). CONCLUSIONS: Quality of pathology reporting improved markedly over the period, in parallel with adoption of standardised synoptic pathology reports. By 1999, recording of important prognostic information was almost complete. Frequency of favourable prognostic factors generally increased over time, reflecting expected effects of mammographic screening.

Adenocarcinoma↗
PubMed1996

What many of us are doing or should be doing in clinical pathology: a list of the activities of the pathologist in the clinical laboratory.

Mr. Paul Mango, Chief Operating Officer of a hospital-based clinical laboratory network in Pittsburgh, recently performed a survey of patients presenting for phlebotomy. The survey included the question, "What does a pathologist do?" The results were that 50% of the patients had no idea what a pathologist did, and 30% of the patients stated that pathologists examined dead bodies. It is not surprising that there is a limited understanding by patients of the activities of pathologists because patients do not usually see pathologists. However, beyond autopsy and surgical pathology, the activities of pathologists are also not well known to nonpathologist physicians and hospital administrators. A poor understanding of activities in clinical pathology have placed these clinical responsibilities of the pathologist under particular scrutiny for cost reduction. The quantitation of output from anatomic pathology, in number of slides reviewed or number of autopsies performed, is objective and easily understood. As noted in the list of clinical pathology activities that follows, the responsibilities within the clinical laboratory are highly diverse and, if the pathologist handles them successfully, highly contributory to patient care. Thus, it is timely that a compilation of activities in clinical pathology be issued for review by the pathologist community. I would hope that this list will serve as a starting point for a universally accepted group of activities that describes clinical pathology today and that it will be useful for pathologists to make their significant contributions in the clinical laboratory apparent to administrators, fellow physicians, and patients. The clinical laboratory responsibilities should also be valuable to directors of residency training programs to focus training in clinical pathology toward the development of currently desirable expertise.

Clinical Laboratory Techniques↗
PubMed2005

The role of second opinion pathology in the management of lesions of the head and neck.

PURPOSE OF REVIEW: Medical error is a common problem, and its human cost in terms of disability, suffering, and death is stunning. Steps toward reducing medical error will require the identification of mistake-prone practices within a complex health care system. Erroneous pathologic diagnosis has been identified as one source of error. This review was undertaken to assess the magnitude of diagnostic imprecision in lesions of the head and neck, and to address the validity of mandatory review of pathology material for patients who are referred from one institution to another for management of tumors involving the head and neck. RECENT FINDINGS: Mandatory second opinion pathology consistently uncovers discrepancies across all major organ systems and has a profound impact on management and prognosis. Site-specific studies have implicated the head and neck as a high-risk area that is prone to diagnostic error. Diagnostic discrepancy rates have ranged from 1 to 53% for surgical pathology studies and from 17 to 60% for cytopathology studies. Major changes (affecting treatment or prognosis) occur in 5 to 7% of surgical pathology cases. The thyroid is consistently identified as a site that is particularly prone to diagnostic discrepancies; and no specific head and neck sites are immune to diagnostic error. SUMMARY: Limited studies addressing the site-specific impact of second opinion pathology implicate the head and neck as a high-risk area that is prone to major changes in diagnoses. Accordingly, mandatory second opinion pathology makes good clinical and risk management sense for all patients referred to head and neck surgery or oncology services before a major therapeutic endeavor is undertaken.

Head and Neck Neoplasms↗
PubMed1990

Pulmonary tuberculosis. An occupational hazard for pathologists and pathology technicians in Japan.

The incidence of pulmonary tuberculosis among pathology workers in Japan is elevated, presumably due to frequent exposure to tubercle bacilli in the work place. To demonstrate the etiological significance of the association between this disease and occupation epidemiologically, a questionnaire survey was performed to assess the incidence of pulmonary tuberculosis among 1,201 pathologists and 1,187 pathology technicians throughout Japan. Pathology department workers other than pathologists and technicians, such as secretaries (n = 207), and workers in university departments of preventive medicine and public health (n = 732) served as control groups. While non-occupation-related tuberculosis was found in both departmental groups with nearly equal incidence, the incidence of pulmonary tuberculosis among pathologists and pathology technicians after engagement in their current specialist work was significantly higher than that in the control groups (odds ratio = 6.08-10.98). The incidence of disease among pathology technicians who assisted in autopsies was markedly higher than among those not involved in autopsies (odds ratio = 6.65). This elevated incidence was significantly related to the duration of work in pathology activities, and showed little change over the last decade. These findings indicate that specific environmental conditions in pathology departments, particularly autopsy of cadavers harboring active tuberculosis, constitute a serious occupational hazard.

Adult↗
PubMedDate not supplied

A review of 1H nuclear magnetic resonance relaxation in pathology: are T1 and T2 diagnostic?

The longitudinal (T1) and transverse (T2) proton (1H) nuclear magnetic resonance (NMR) relaxation times of pathological human and animal tissues in the frequency range 1-100 MHz are archived, reviewed, and analyzed as a function of tissue of origin, NMR frequency, temperature, species, and in vivo versus in vitro status. T1 data from specific disease states of the bone, brain, breast, kidney, liver, muscle, pancreas, and spleen can be characterized by simple dispersions of the form T1 = AvB in the range 1-100 MHz with A and B empirically determined pathology-dependent constants. Pathological tissue T2 values are essentially independent of NMR frequency. Raw relaxation data, best-fit T1 parameters A and B, and the mean T2 values, are tabulated along with standard deviations and sample size to establish the normal range of pathological tissue relaxation times applicable to NMR imaging or in vitro NMR examination. Statistical analysis of relaxation data, assumed independent, reveals that most tumor and edematous tissue T1 values and some breast, liver, and muscle tumor T2 values are significantly elevated (p greater than or equal to 0.95) relative to normal, but do not differ significantly from other tumors and pathologies. Statistically significant abnormalities in the T1 values of some brain, breast, and lung tumors, and most pathological tissue T2 values could not, however, be demonstrated in the presence of large statistical errors. Both T1 and T2 in uninvolved tissue from tumor-bearing animals or organs do not demonstrate statistically significant differences from normal when considered as a group, suggesting no appreciable systemic effects associated with the presence of tumors compared to the statistical uncertainty. Statistical prediction analysis for both T1 and T2 indicates that of all the tissues studied, only liver hepatoma can be reliably distinguished from normal liver based on a single T1 measurement (p greater than or equal to 0.95) given the scatter in the current published data. Indeed, data scatter, not easily attributable to temperature, species, in vivo versus in vitro status, the inclusion of implanted or chemical induced tumors, or the possible existence of multiple component relaxation, is recognized as the major factor inhibiting the diagnostic utility of quantitative NMR relaxation measurements. Malignancy indexes that combine T1 and T2 data as a diagnostic indicator suffer similar problems of uncertainty. The literature review reveals a dearth of information on the temperature and frequency dependence of pathological tissue relaxation and the possible existence of multiple relaxation components.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1988

Review of pathology data for regulatory purposes.

This paper describes the review process for pathology data submitted to the Division of Pathology, Center for Food Safety and Applied Nutrition of the Food and Drug Administration. The Division of Pathology independently evaluates the pathology data submitted in support of the safety of a given compound. The submissions are examined for agreement between summarized information and data from individual animals, appropriateness of terminology applied to lesions, and adequacy of information (distribution and severity of observed lesions). Problems and concerns encountered during review sometimes require examination of microscopic slides. The slide review provides an independent characterization of the lesions and a verification of their incidence. We present some problems commonly encountered in our review of the pathology data and describe some recent pathology evaluations. Finally, we suggest some considerations for reporting pathology data that may facilitate regulatory review.

Animals↗
PubMed2025

Serum N-glycomics for non-invasive detection of significant liver pathology across clinical phases of treatment-na&#xef;ve chronic hepatitis B.

BACKGROUND: Early identification of significant liver pathology is crucial for timely antiviral intervention in individuals with chronic hepatitis B (CHB) infection. Current non-invasive methods show limited accuracy in detecting occult liver damage, particularly in those with normal ALT. This study evaluated serum N-glycan profiles for diagnosing significant liver pathology in treatment-na&#xef;ve CHB patients across clinical phases. METHODS: This cross-sectional study analyzed 626 treatment-na&#xef;ve CHB patients confirmed by liver biopsy, classified according to 2025 EASL guidelines. Serum N-glycan profiles were determined using DNA sequencer-assisted fluorophore-assisted carbohydrate electrophoresis. Significant liver pathology was defined as inflammation grade&#x2009;&#x2265;&#x2009;G2 and/or fibrosis stage&#x2009;&#x2265;&#x2009;S2 (per Scheuer scoring system). Multivariate logistic regression models were developed and compared with traditional non-invasive markers. RESULTS: Among 626 CHB patients, 66.0% had significant inflammation and 58.9% had significant fibrosis. Patients with significant pathology showed characteristic alterations, with elevated P1, P3, P6, P7, P11 peaks and decreased P0, P5, P8, P10 peaks (all p&#x2009;<&#x2009;0.0001). Compared to respective infection phases, hepatitis phases showed P1 increases of 19.6% and 36% in HBeAg(+) and HBeAg(-) patients, with P11 increases of 82.4% and 73.4%, while P0 decreased by 20.3% and 27.6%, and P10 by 21.6% and 20.3%. Relative to mild pathology (G and S&#x2009;<&#x2009;2), P1 increased by 27% in significant pathology (G and/or S&#x2009;&#x2265;&#x2009;2), reaching 58.7%/48.7% in G4/S4 stages (vs. G0/S0). In ALT-normal HBeAg(+) infection phase, P1 increased by 80.2%/65.8% in G4/S4 stages (vs. G0/S0), with P2 also increasing by 54.1%/45.2%. Multivariate analysis identified P11 as strongest risk factor (OR&#x2009;=&#x2009;3.84, 95%CI: 1.74-8.45, p&#x2009;=&#x2009;0.0008), followed by P1 (OR&#x2009;=&#x2009;2.04, 95%CI: 1.57-2.64, p&#x2009;<&#x2009;0.0001) and P7 (OR&#x2009;=&#x2009;1.75, 95%CI: 1.31-2.34, p&#x2009;=&#x2009;0.0002), while P2 (OR&#x2009;=&#x2009;0.07, 95%CI: 0.02-0.26, p&#x2009;<&#x2009;0.0001) and P0 (OR&#x2009;=&#x2009;0.30, 95%CI: 0.12-0.79, p&#x2009;=&#x2009;0.0140) served as protective factors. The glycomics combined model (AUC&#x2009;=&#x2009;0.876 (0.844-0.908)) achieved superior performance and outperformed the clinical model (AUC&#x2009;=&#x2009;0.818 (0.779-0.857)), LSM (AUC&#x2009;=&#x2009;0.817 (0.775-0.858)), APRI (AUC&#x2009;=&#x2009;0.830 (0.792-0.867)), and FIB-4 (AUC&#x2009;=&#x2009;0.672 (0.621-0.723)) (all p&#x2009;<&#x2009;0.001), with 78.7% sensitivity and 83.2% specificity. The optimized model reached AUC&#x2009;=&#x2009;0.917 (0.891-0.942) with accuracy 84.2%, with 78.7% sensitivity and 94.6% specificity. Both glycomics-based models maintained diagnostic capability in ALT-normal patients particularly in HBeAg(+) infection. CONCLUSIONS: Serum N-glycomics demonstrates promising potential for non-invasive identification of significant liver pathology in treatment-na&#xef;ve CHB patients, providing an alternative approach for early treatment decisions, especially in ALT-normal patients with occult liver damage.

Humans↗
PubMed2006

Curriculum content and evaluation of resident competency in clinical pathology (laboratory medicine): a proposal.

Ten years have passed since the Graylyn Conference Report on Laboratory Medicine/Clinical Pathology training was issued. During that period, the Accreditation Council for Graduate Medical Education (ACGME) substantially revised the requirements for training programs, the American Board of Pathology (ABP) amended the requirements and the time needed for certification, and the discipline itself along with the broader discipline of pathology, evolved significantly. Recently, a curriculum proposal in anatomic pathology was published as a potential template to be used by training programs to help meet these new and evolving needs. Toward the same end, the Academy of Clinical Laboratory Physicians and Scientists has developed a template for a curriculum in clinical pathology (laboratory medicine), taking into account newly designated and revised areas of residency core competency, the alterations in training requirements promulgated by the ACGME and ABP, and the rapidly developing nature of the discipline itself The proposed clinical pathology curriculum defines goals and objectives for training, provides guidelines for instructional methods, and gives examples of how outcomes can be assessed. This curriculum is presented as a potentially helpful outline for use by pathology residency training programs.

Clinical Competence↗
PubMed2006

Curriculum content and evaluation of resident competency in clinical pathology (laboratory medicine): a proposal.

Ten years have passed since the Graylyn Conference Report on Laboratory Medicine/Clinical Pathology training was issued. Over that time period, the Accreditation Council for Graduate Medical Education (ACGME) substantially revised the requirements for training programs, the American Board of Pathology (ABP) amended both the requirements and the time periods needed for certification, and the discipline itself, along with the broader discipline of pathology, evolved significantly. Recently, a curriculum proposal in anatomic pathology was published as a potential template to be used by training programs to help meet these new and evolving needs. Toward the same end, the Academy of Clinical Laboratory Physicians and Scientists has now developed a template for a curriculum in clinical pathology (laboratory medicine), taking into account newly designated and revised areas of residency core competency, the alterations in training requirements promulgated by the ACGME and ABP, and the rapidly developing nature of the discipline itself. The proposed clinical pathology curriculum defines goals and objectives for training, provides guidelines for instructional methods, and gives examples of how outcomes can be assessed. This curriculum is presented as a potentially helpful outline for use by pathology residency training programs.

Clinical Competence↗
PubMed1993

Teaching anatomical pathology in an integrated self-directed learning programme: the Newcastle experience.

In accordance with the teaching philosophy of the Faculty of Medicine at the University of Newcastle we attempt to "teach" Anatomical Pathology by directing the students' own learning. Thus we do not give a standard general and systematic pathology course. We aim to integrate pathology with other disciplines and in this we feel we are very successful. We use the small number of Fixed Resource Sessions to lay the foundations in basic pathology and to provide an overview of major areas for study. Further guidance is given in the form of Learning Goals. Clinico-Pathological Conferences are used extensively to highlight various areas. These sessions are supplemented by the wide availability of microscopy material and open access to autopsies. A high level of interest in Anatomical Pathology is exhibited by the medical students in the Faculty, as demonstrated by the large numbers who attend autopsies and who choose to undertake electives in Anatomical Pathology.

Education, Medical, Undergraduate↗
PubMedDate not supplied

Pathology as a profession: contribution of undergraduate training on choice of career among final year students of a medical school in north central Nigeria.

BACKGROUND: The choice of pathology as a profession by would be resident doctors, will, to a large extent depend on the amount of knowledge acquired on the subject at the undergraduate level. METHODS: A questionnaire was self administered to final year medical students of University of Jos shortly after the completion of the final written paper in medicine in September 2005; meant to elicit their views on choosing patology as a profession after graduation. RESULTS: Eighty-five students enrolled comprising 65 (76.5%) males and 20 (23.5%) females Ninety six percent of the students were between 26 and 30 years. Those who found Pathology interesting were 76.5%; 18.8% picked pathology as their career of first choice after graduation 5.9%, 3.5% and 5.9% as 2nd, 3rd and 10th choices repectively. Among the pathology disciplines, 8.2%, 4.7%, 3.5% and 2.4% would specialize in Histopathology, Haematology, Chemical Pathology and Medical Microbiology respectively. The students generally complained of inadequate time and exposure during the postings as well as the difficulty in understanding Medical Microbiology. CONCLUSION: More time should be allocated to the teaching of Pathology at the undergraduate level. Learning enhancing aids should be introduced such as: regular practical demonstrations, audio-visual teaching aids, computer assisted programs and the establishment of pathology museums in the medical schools across the country.

Adult↗
PubMed2003

Concept-match medical data scrubbing. How pathology text can be used in research.

CONTEXT: In the normal course of activity, pathologists create and archive immense data sets of scientifically valuable information. Researchers need pathology-based data sets, annotated with clinical information and linked to archived tissues, to discover and validate new diagnostic tests and therapies. Pathology records can be used for research purposes (without obtaining informed patient consent for each use of each record), provided the data are rendered harmless. Large data sets can be made harmless through 3 computational steps: (1) deidentification, the removal or modification of data fields that can be used to identify a patient (name, social security number, etc); (2) rendering the data ambiguous, ensuring that every data record in a public data set has a nonunique set of characterizing data; and (3) data scrubbing, the removal or transformation of words in free text that can be used to identify persons or that contain information that is incriminating or otherwise private. This article addresses the problem of data scrubbing. OBJECTIVE: To design and implement a general algorithm that scrubs pathology free text, removing all identifying or private information. METHODS: The Concept-Match algorithm steps through confidential text. When a medical term matching a standard nomenclature term is encountered, the term is replaced by a nomenclature code and a synonym for the original term. When a high-frequency "stop" word, such as a, an, the, or for, is encountered, it is left in place. When any other word is encountered, it is blocked and replaced by asterisks. This produces a scrubbed text. An open-source implementation of the algorithm is freely available. RESULTS: The Concept-Match scrub method transformed pathology free text into scrubbed output that preserved the sense of the original sentences, while it blocked terms that did not match terms found in the Unified Medical Language System (UMLS). The scrubbed product is safe, in the restricted sense that the output retains only standard medical terms. The software implementation scrubbed more than half a million surgical pathology report phrases in less than an hour. CONCLUSIONS: Computerized scrubbing can render the textual portion of a pathology report harmless for research purposes. Scrubbing and deidentification methods allow pathologists to create and use large pathology databases to conduct medical research.

Computing Methodologies↗
PubMed2004

Use of physician extenders in surgical pathology practice.

CONTEXT: Use of a variety of nonphysician personnel for surgical pathology gross examination is generally known to be increasing, although detailed information regarding nonphysician use is currently unavailable. OBJECTIVE: To measure and describe the use of nonphysician personnel for surgical pathology gross examination in order to gain a better understanding of the current surgical pathology workforce. DESIGN: A voluntary, mailed questionnaire containing items related to the use of multiple nonphysician personnel types in surgical pathology was distributed to (1) a cross-sectional sample (n = 968) of US pathologists and (2) a purposive sample of pathologist directors of surgical and/or anatomic pathology (n = 77) located at teaching institutions. Responses were analyzed using descriptive statistics, correlation analyses, the chi2 test, and 1-way analysis of variance. Staffing ratios were calculated for multiple nonphysician personnel types. RESULTS: The overall response rate was 22% (n = 225). Of the US sample, 56% of respondents reported using nonphysician laboratory personnel to perform gross examinations, compared with 91% of the directors' sample. The most frequently reported personnel type for both samples was pathologists' assistants, but multiple other personnel types were used as well. Significant associations existed between certain practice types and personnel types used, as well as differences in the scope of responsibilities between personnel types. Calculated staffing ratios were variable across personnel types and were highest for pathologists' assistants. CONCLUSIONS: The use of a variety of nonphysician laboratory personnel for surgical pathology gross examination is common, particularly in academic pathology practice. Further studies are needed to examine the impact of physician extenders on laboratory efficiency and quality of care.

Pathology, Surgical↗
PubMed2006

Longitudinal case-based evaluation of diagnostic competency among pathology residents: a statistical approach.

CONTEXT: Accreditation Council for Graduate Medical Education guidelines require the evaluation of residents in 6 competencies. Pathology residents demonstrate medical knowledge, patient care, communication, and practice-based learning competencies in their attainment of competency in surgical pathology diagnosis. OBJECTIVE: To implement a prospective case-based approach to longitudinally evaluate the acquisition of competency in surgical pathology diagnosis by trainees. DESIGN: Each resident made his or her surgical pathology diagnosis on cases before faculty review of the cases. Faculty members scored each resident diagnosis as to whether they agree, partially agree, or disagree with the diagnosis. Forty-three months of surgical pathology reports (August 2001 through January 2005) and 22,252 surgical pathology cases were analyzed. SETTING: Pathology residency program. PARTICIPANTS: Thirteen faculty members and 21 trainees. MAIN OUTCOME MEASURE: Time and training year trends for the number of cases reviewed and the percent agreement between faculty and trainees on the diagnoses. RESULTS: A mean of 146 cases (range, 12-327 cases) was reviewed during each month-long rotation. The number of cases reviewed increased through postgraduate year 4. The percent agreement on the diagnoses was 78% (range, 56%- 99%) for all trainees, with improvement by postgraduate year, although the improvement attenuated by postgraduate year 3. Residents were less likely to preview the most complex cases. Faculty rank and sex and resident sex did not significantly affect outcomes. The overall agreement on the diagnoses increased over time. Residents experiencing difficulty could be identified clearly and early. CONCLUSIONS: Individual resident performance was easily tracked over time. The review of hundreds of reports increases systems accountability and allows more objectivity than traditional evaluations. The use of case-based evaluation fosters earlier identification and remediation of deficiencies.

Case Management↗
PubMed2006

Pediatric surgical pathology: pitfalls and strategies for error prevention.

CONTEXT: Few data exist regarding quality measures for pediatric surgical pathology, types of errors, or how error-prone situations and diagnostic pitfalls can be minimized. OBJECTIVE: This review reports on survey findings regarding methodology for quality assurance and error detection measurement and classification in pediatric surgical pathology. It presents information regarding, and quality aspects of, intraoperative consultations in pediatric surgical pathology. General strategies for identifying diagnostic pitfalls in pediatric surgical pathology are briefly discussed. DATA SOURCES: A survey of children's hospitals based on a survey created by the Association of Directors of Anatomic and Surgical Pathology, literature review, and institutional quality assurance records provided information for this review. CONCLUSIONS: Approaches to quality assurance and error reduction in pediatric surgical pathology are similar to those used in general surgical pathology. The children's hospitals that were surveyed used a variety of standard quality assurance measures. Because of differences in data collection, classification, and reporting, it is not possible to provide a detailed analysis of the types of diagnostic error across institutions at this time. Intraoperative consultations are a potential source of error. Pediatric neoplasms and Hirschsprung disease account for the majority of intraoperative consultations in the pediatric setting. Further considerations include the unique aspects of pediatric medical and neoplastic disorders and special diagnostic criteria, classification, grading, and staging requirements.

Adolescent↗
PubMed2000

[Responses in a questionnaire by medical school students who participated in the new curriculum of the clinical learning in clinical pathology].

The clinical learning taken by medical students are an important part of their medical education. To develop a new, effective curriculum for the clinical learning in Clinical Pathology, the instructors defined clear general instructional objectives and specific behavioral objectives, and discussed the learning strategies and evaluation methods. The medical students at our medical school took this new curriculum in Clinical Pathology in 1999. As an evaluation method of this new curriculum, we asked all students to fill out a questionnaire that asked their opinions about the length of each component in the Clinical Pathology rotation, the content of the rotation, etc. Over 80% of the respondents answered that the rotation in Clinical Pathology was useful. Ninety-six percent of the students felt that the experience and knowledge they gained in this Clinical Pathology rotation will be useful in the clinical learning in other departments. Based on the high percentage of favorable responses from the students, we concluded that the new curriculum, which was developed after intensive planning, was successful. In summary, the feedback from students who took the new curriculum in Clinical Pathology showed that this new course was well-accepted by the students and that it created an excellent relationship between the instructors and students. Some of the responses in the questionnaires will be used to improve the Clinical Pathology rotation in the future.

Consumer Behavior↗
PubMed2001

[Is disease grounded in the mind, the spirit or communication? Pathology as a leading path in learning about disease].

What is the reason, why pathology could command a dominating position as a central teaching discipline in the last 150 years? Furthermore: can this position be maintained in the future? Pathology takes its definitive stand in the philosophic confrontation of "Mind" versus "Matter". It guards the dogma of Morgagni: every disease is reflected by its typical morphological substrate. As long as this dogma is guarded and defended by the discipline of pathology, we will stay at the helm of teaching in medicine. Recently information as a third reality (besides mind and matter) has come into existence. Information is defined here as genomic information specifically the differentially activated functional genomics. In extension to the old dogma of Morgagni we recognize now an extension to "functional" diseases where we do not (yet) find a pathological anatomical manifestation. In these cases "information" is defined as differences in physical states. They can be converted to information in the sense of meaning and purpose by communication. Pathology provides the bridge between functional genomics and morphological manifestations of diseases (phenomics). The future of pathology is based on the amalgamation of the old and reliable Morgagni-Virchow dogma with the new informational dogma. If pathology provides sense, meaning and significance to phenomics, morphology in relation to functional genomics it will retain and even enlarge its influence as the most important teaching discipline in medicine.

Communication↗
PubMed2001

[A new Approbation Order for teaching medical pathology].

A basic reform and a draft of a new approbation order were developed during the last years to improve medical education in Germany. Aims of this reform are to link the theoretical and practical teaching, to foster the interdisciplinary teaching, to promote case- and problem-based instruction, to reduce written multiple choice examinations, and to promote oral exams. During the discussion about the reform proposals were made to put much more weight on the social and psychological aspects of health care and to reduce the teaching of a science-based understanding of disease, for which pathology stands. In the final draft of the reform, however, pathology was maintained as subject of clinical education. Decisive changes now include, that the traditional distinction between general and special pathology will be abolished, and that a case- and problem-based teaching by interdisciplinary clinical-pathological conferences will be fostered. Thus the education will consist of a systematic lecture and practical sessions in pathology, which have to focus on the basic principles of the etiology, pathogenesis and classification of human diseases. Practical clinical aspects of pathology will then be thought by problem-based and interdisciplinary clinical pathological conferences or demonstrations, which start in the 4th year of the curriculum and have to be continued during the practical year's term until the end of the studies. Presently the new approbation order still requires consent of the Bundesrat. It depends on agreement about the limitation for the maximum number of students, the regulation of admittance to the medical education and the cost effects of the reform. There are some indications that solutions of these problems might be achieved during 2001.

Education, Medical↗