What inspired you to pursue pathophysiology?
I am not a pathologist by education; I am an immunologist by PhD and postdoctoral training, internist by clinical specialty, and pathophysiologist by interest and academic tenure. I have always been intrigued by the pathway from health to disease and vice versa and those processes have inspired me throughout my professional life. Pathophysiology is an integrative discipline that bridges the clinical and basic sciences – using data, methodologies, concepts, diagnostic procedures, medical histories, basic scientific discoveries, and knowledge to determine etiopathogenesis.
Since childhood, I have been fascinated by the mechanisms and principles of technology – and I remain intrigued by the mystery of life and death and by the things that separate one from the other. At university, there were teachers who researched functional changes at the macromolecule level; however, when I obtained my MD degree, I was still not happy with my understanding of medical physiology, despite having gained copious amounts of knowledge. Thus, pathophysiology was a natural next step.
What are the most important principles you adhere to when teaching?
As a teacher of medicine, I am an interpreter of health and disease. As such, I always make a clear distinction between reliable, proven knowledge and postulated, conceptual frameworks with fragmented or partial supporting data. Furthermore, I never believe that I know everything. Regardless of how highly you are praised as a teacher, it’s important to admit when you don’t know something – and important for students to have the courage to speak up when they don’t understand something. This honesty helps build reliable relationships and trust between teachers and students.
Teaching protocols and study materials should be built on three postulates – maximum insight into the problem, logical consistency of interpretation, and daily practical reinforcement. These three pillars contribute to solid, reliable interpretation as a basic prerequisite to understanding disease processes. They have been increasingly important in the era of information overload, increasing complexity, and widespread availability of big data in biomedicine. Not all of those data are directly applicable to practical medicine – but some directly clarify certain facets of etiopathogenesis.
Tell us about your summer school in pathophysiology…
The Dubrovnik Summer School of Pathophysiology was designed to combine cutting-edge scientific research with the inquiring spirits of young biomedical professionals and advanced students. This year, the theme was “Adaptive Wisdom of Human Body Reactivity” – a framework for various facets of physiology. We focused on four challenging themes: artificial pulsing (pressure-driven blood vessel differentiation); PD-1/PD-L1 checkpoint therapies in clinical tumors; prevention of disease by other diseases in comorbid conditions; and the role of methylation and demethylation in embryonic differentiation. We deliver all this content in a more relaxed environment than traditional academia, with an emphasis on straightforward teaching. There is also the bonus of learning in a Mediterranean environment with an easygoing attitude that has contributed to the creative and productive spirit of the summer school.
What has been the most unexpected moment of your career thus far?
I was convinced, based on years of evidence, that the tiny fraction of students who failed their pathophysiology board exam more than three times would never be able to pass it at all. However, a few years ago, I was pleasantly proven wrong. A student who was repeating the course – and taking the exam for the eighth time – presented a knowledge and understanding of pathophysiology that distinguished him as the “cream of the crop.” When I asked him why he had failed so many times, he simply replied that he had been trying to pass without preparation. This time, he had made it a job and put the work in. This completely changed my understanding of students’ psychology – and their abilities.
On the clinical side, one of my patients with a heart problem died overnight. I had spoken with her the day before about medical history and related issues, but we had also discussed theater and music. Her communication skills were normal and she had no family history of significant disease; however, upon postmortem examination, I found something surprising – almost the whole left hemisphere of her brain was absent! The attending pathologist said he had never seen such a structural deficit before in a high-functioning individual. That unexpected (but impressive) finding shifted my perspective of the human body’s capacity to adapt.
You have published several pathophysiology textbooks. Do you have any plans for more educational materials?
I have two plans. First, I have already initiated a project in nosology (the study of individual diseases’ etiopathogeneses) that will connect these etiopathogeneses with the corrective effects of pharmacological interventions. A graph approach may be suitable for clear presentation of the interplay between diseases and therapies.
Second, my group has been working on adjusting, coding, and integrating current pathophysiology knowledge for interactive electronic media. We would like to make disease etiopathogenesis schemes instantly available via users’ mobile devices.
What advice would you give to pathologists and physiologists at the start of their careers?
Motivation and curiosity are key to solving complex issues, but active participation in teaching and learning yields the best results. Make sure to integrate your knowledge by applying your understanding of pathology and physiology to the context of whole-body functioning. The best students are those who never stop questioning – and it is their curiosity that will distinguish them in their careers.
What advice would you give to your fellow educators?
The practice of medicine is increasingly fragmented into smaller and smaller specializations, reduced scopes of interest, siloed departments, and isolated clinical branches. Though there are advantages to this, keep in mind that human body physiology, by nature, is not compartmentalized. We need an integral understanding of human health alongside specific fields, because many diseases cannot be squeezed into the narrow limits of a small subspecialty.
American theoretical physicist and Nobel prizewinner Richard Feynman gave simple instructions for being an effective educator. He said, “First, figure out why you want the students to learn the subject and what you want them to know, and the method will result more or less by common sense.” I believe this is valid for all educators – including those who teach human physiology of health and disease. Finally, make sure to read two scientific papers every day. Making this a habit will keep you up to date with new information and practices in the field.
Zdenko Kovač is Professor of Pathophysiology and Internist at the University of Zagreb School of Medicine, Zagreb, Croatia
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