Missing Links in the Curriculum

Osteopathic medical programs offer a holistic, hands-on approach to training, but is limited pathology exposure preventing opportunities for medical students? It was this question that inspired a recent study aiming to identify the gaps in COCA-accredited osteopathic medical schools, published in Academic Pathology. Here, Peace Preston and Meredith Herman, lead and corresponding authors, report on their learnings, and share their hopes for the future of osteopathic medical education.

Can you tell us about the key findings of your study?

The study highlights substantial variability in pathology education across osteopathic medical schools. While some programs integrate pathology into foundational sciences through lectures, case-based learning, and histopathology labs, clinical exposure remains inconsistent. This is largely due to the community-based nature of many clinical training sites, which vary in size and pathology exposure opportunities even within the same school.

Faculty availability also varies significantly: out of 61 accredited osteopathic colleges, some had no physician pathologists on staff, and only 12 percent had deans with a background in pathology. These gaps in dedicated pathology expertise are particularly striking. Additionally, while only 1.06 percent of DO students matched into pathology residency from 2021 to 2024, the proportion of pathology positions filled by DO applicants increased from 9.8 percent to 16.7 percent, suggesting a growing presence of DOs in the specialty despite persistently low match rates from within their own student cohort.

Together, these findings underscore the urgent need for curriculum reform, greater investment in pathology faculty, and stronger collaboration with pathology departments to ensure osteopathic students receive consistent, high-quality exposure to this essential medical specialty.

Why do you think many schools don’t have dedicated pathology courses or departments? 

There are several reasons why many osteopathic schools lack dedicated pathology departments or courses. The curriculum in DO programs focuses more heavily on the musculoskeletal system and primary care, which differs from the biomedical science-intensive approach of MD programs. This emphasis may lead to pathology being less prioritized as a core subject.

Moreover, most osteopathic students train in community settings that often lack specialized pathology departments, limiting their clinical exposure. Unlike MD schools, osteopathic institutions do not sponsor pathology residency programs and have limited partnerships with external pathology labs, reducing opportunities for hands-on learning.

Faculty shortages further compound the issue – many schools have few or no full-time pathology faculty. Some bring in visiting pathologists to teach, but these individuals are often not officially part of the faculty. Leadership is also limited: only a small number of osteopathic schools have deans with pathology backgrounds, which suggests weak institutional support and advocacy for pathology education.

How does this impact students’ exposure to the field?

The variability in didactic and lab teaching means some students receive limited or fragmented instruction, leaving gaps in their foundational knowledge. Clinical experience is often minimal due to the lack of specialized pathology departments at training sites. With few faculty mentors or role models, students have fewer opportunities to explore pathology as a career. Ultimately, this environment leads to lower preparedness and diminished interest in the field, reflected in persistently low match rates despite growing DO representation among pathology residents overall.

Some schools had slightly higher match rates into pathology – what were they doing differently?

Some osteopathic schools with slightly higher pathology match rates (up to about 5 percent) tend to share certain strengths, though results can vary by class and student interest. These schools usually have more involvement from pathologists who offer mentorship and serve as role models. They also feature dedicated pathology courses or better integration of pathology into lectures and lab work.

In addition, they often maintain stronger ties to pathology labs or larger hospitals, giving students more real-world experience. Leadership by pathologists or strong departmental advocacy helps raise the profile of the specialty and encourages students to pursue it. Together, these elements help create a learning environment that boosts student interest in pathology and prepares them better for residency.

How important is hands-on exposure in helping students decide if pathology is right for them?

Hands-on experience – such as electives or clerkships – is crucial in helping students decide if pathology is the right career for them. Our findings and past research suggest that many osteopathic medical schools don’t offer enough of these experiences, which creates a major barrier to students exploring and understanding the field.

While some schools include pathology in lectures, case studies, and lab work, this classroom learning needs to be reinforced with real clinical exposure. Watching how pathology is used in actual patient care helps students connect what they’ve learned with how diagnoses and treatment decisions are made.

During clinical rotations, students can see pathologists in action – handling specimens, examining tissue under the microscope, and writing diagnostic reports. These experiences are often missing in community hospitals that don’t have pathology departments. As a result, students not only miss out on seeing how pathology impacts patient care – like confirming a diagnosis or checking surgical margins – but also lose valuable opportunities to connect with mentors and role models.

Since many osteopathic schools lack full-time pathology faculty or leadership, these in-person experiences are even more important. Without direct exposure, students may also miss learning about the broader roles of pathologists in areas like transfusion medicine, clinical chemistry, and microbiology.

What practical changes can medical schools make to improve pathology education without major structural changes?

Improving pathology education in osteopathic medical schools doesn’t require major overhauls – we can make a big difference by enhancing existing efforts and creating smarter partnerships. From our research and conversations with students and educators, it’s clear that the main issue isn’t a lack of interest in pathology, but rather a lack of access and exposure.

We can better integrate pathology into foundational science courses and clearly present it as its own medical specialty – not just a topic in a textbook. Many schools already include lectures, case-based learning, and histology labs, but these are often inconsistent. Standardizing clinical case discussions and using virtual microscopy tools can help give all students a stronger, more consistent foundation in pathology. Even small changes, like highlighting how pathology connects to real patient care, can make a big impact.

Stronger partnerships are also key. Most DO students train at community hospitals that often lack in-house pathology services or offer uneven experiences. But where these labs do exist, schools can encourage students to rotate with local pathologists and allow those experiences to count toward graduation. Collaborating with academic centers or independent labs can open up more elective or observational opportunities. Even virtual rotations or telepathology sessions can give students access when in-person options aren’t possible. 

Pathology interest groups can also play an important role, especially in schools where clinical exposure is limited. These groups let students explore pathology early through workshops, case discussions, shadowing, and mentorship. They help students understand the specialty’s importance in diagnosis and patient care, while also building a sense of community and sparking interest in pathology as a career.

Finally, mentorship is essential – even in schools with no pathology faculty or leadership. It can come in many forms: part-time or visiting pathologists, remote mentors through alumni networks, or career panels and Q&A sessions. These connections can help students see themselves in the field, even if they don’t have formal in-house mentors.

None of these changes are drastic, but they are practical, scalable, and effective. By making pathology more visible, accessible, and hands-on, we can help students better understand its value – and maybe inspire more of them to pursue it as a career.

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