What drew you to both pathology and education?
I was always interested in the combination and application of the basic sciences in medicine. I found that studying the mechanisms of diseases was so instructive to me in terms of understanding how we diagnose and treat them.
Equally, I was that kid in high school who happily volunteered to tutor other students. Prior to medical school I did some work for the education company, Kaplan Test Prep. And, during medical school itself, I was enlisted to facilitate a number of courses on the basic sciences and their application into medicine – including gross anatomy and pathology sessions in the organ-based curriculum.
And so, as I was approaching the end of medical school, I found myself caught between two passions: one for education, and one for understanding the mechanistic underpinnings of disease and how those translate into its management and treatment.
I naturally opted for the pathology residency – with the recognition that I really wanted to spend the bulk of my career teaching medical students. I liked the idea of touching even more patients' lives through the competency and expertise of the physicians I taught.
Is that what motivated your switch from clinical practice to become a full-time educator at the Sidney Kimmel Medical College?
There were actually a few parts to that decision. First, I came to realize that the types of projects that motivate me are those that evolve over months or years. While I certainly enjoyed the practice of pathology, and valued working in patient care, I recognized that the responsibilities were focused on the day-to-day workflow. When I compared that to my teaching responsibilities – where I might be working with students over all four years of their medical education – I found that I really wanted to maximise that part of my career.
I also found myself interested in curriculum and resource development, educational technology, and student assessment, and was keen to leverage those aspects of my portfolio.
Jefferson was advertising a full-time anatomy educator position and I originally applied for that, with anatomy being my other area of expertise. During the application process, they picked up on my pathology background, and asked if I’d like to be considered for the Thread Director role for pathology. It was an enthusiastic “Yes” from me.
Now I get to spend one hundred percent of my time focused on really high-quality education and creating an excellent student experience – with the intention that their experience and knowledge will develop them into the astute, caring physicians their patients deserve.
What have been your biggest achievements or highlights as Thread Director of Pathology?
Because the Thread Director position had been vacant for a while before I took it on, I enjoyed the opportunity to significantly revamp the pathology thread, adopting a very holistic approach.
A lot of my focus has been on synthesizing the material across the duration of the pathology thread – what’s called vertical integration in the education world – as well as creating connections and frequently teaching alongside our clinical medicine, biochemistry, and anatomy faculties, or horizontal integration.
For example, my colleague (and Chair) Steve Herrine is a hepatologist and transplant surgeon. Together we deliver a session on the mechanisms and histopathology of liver cirrhosis, its potential complications, and treatment – including the management of transplant. In so doing, we connect the underlying pathology and pathophysiology with discussions of gross anatomy, clinical medicine, and surgical management.
I think the students find a lot of value in those sort of integrated sessions where they have the pathologist and the surgeon, nephrologist, or pulmonologist in the room at the same time. Accordingly, they are seeing a lot more co-threaded questions on their examinations, so it’s important they have opportunities to think about pathology alongside clinical medicine in a deeper way.
I have also welcomed the opportunity to involve residents in our medical education programs. That’s a double win because, not only does it help the residents build their own teaching portfolios, but also provides the students with peer support from colleagues who have recently been through medical school.
How would you define a good teacher?
Planning skills are definitely an attribute. It’s important to be able to design content in an intelligent way, so that it has an arc or story that develops during the educational session – be that a lecture, case-based learning, or a team discussion. And you need to be able to articulate that story in a way that reaches diverse, varied students.
You also need to behave as a sort of wrangler of students, recognizing the space that you occupy in their schedules and keeping them focused and on-task, especially in more interactive sessions.
Good teachers are also enablers, in that they create participatory and inclusive environments. They value and promote diversity, equity, and inclusion, despite the fact that those values are very much under attack right now in the US. They recognize that every student brings something additional to the table.
Motivational skills are important in encouraging intentional study and lifelong learning. Generating those sparks of interest is vital – even if a student doesn’t end up pursuing pathology, we want them to appreciate the value of the specialty and recognize how to engage with and work alongside pathologists to ensure the best care for their patients.
I think a good educator is also a partner. They create pathways for good, bi-directional feedback, acting on opportunities for their own continuous improvement and their students’ development.
And, importantly, teaching is about being a guide. We need to provide advice on concerns beyond the classroom, such as professional matters, study skills, and exam technique – that comes up a lot with my students.
What did you learn during your time working for a private education company?
I first started working for Kaplan Test Prep as a fourth year undergraduate student. Kaplan was recruiting people who had performed well in the Medical College Admissions Test (MCAT) and were interested in teaching the exam syllabus. I signed up and started teaching basic sciences and math as well as critical reading and verbal reasoning skills.
That experience taught me that, even for a syllabus as standardized as that for test prep course for the MCAT, students still come into it with varying strengths depending on their previous education and circumstances. Accordingly, I understood that education – even when standardized – needs to be considered and interpreted locally.
I continued the MCAT teaching work into medical school, as well as teaching prep courses for the entry exams for dentistry, optometry, and pharmacy. By the end of medical school I realized that I wanted to direct my career toward education as much as possible, but I still lacked skills in psychometrics and assessment.
To explore that, I took two years off, in between medical school and residency, to work full-time for Kaplan. The MCAT exam was being revised, and I was overseeing the revision of the course materials. That really gave me the chance to explore assessment strategies, statistical methods to understand student performance, and how to design the most effective types of assessment items for a given construct. The experience set me up with invaluable skills for my current position.
How do you think that AI will change medical education as we know it today?
I think AI has the potential to make some very beneficial changes in terms of providing study guidance to students, interpreting written text-based data, and generating ideas for content and resource development. I also think there’s potential for testing students on their knowledge – but we’re not quite there yet.
I conducted my own study, looking at ChatGPT’s ability to produce multiple choice questions for the United States Medical Licensing Examination (USMLE). I asked it to generate 180 questions on nine organ systems. It had no problem completing the task – but the questions contained 290 classifiable errors.
Whilst some were “benign” errors such as failing to alphabetize the answer choices, slightly more than 50 percent were “malignant” errors that could affect future student performance through the presentation of factually incorrect information, inclusion of multiple correct answers, and other similarly egregious violations. I had presented a set of 36 style and content rules for ChatGPT to follow simultaneously, and it just couldn’t do it.
Saying that, I have seen some successful examples of students using ChatGPT to create a study schedule, or instructors asking it to brainstorm clinical cases for the classroom. And it’s great at analyzing data on students’ performance and really highlighting areas for improvement.
However, the more language-driven tasks in education are more problematic. There are more than a few instances in the literature of students and faculty using generative AI to produce entire reports without taking the time to edit and fact check them. In reality, we need to approach that use case with a very high index of suspicion and full recognition of the potential for flaws.
But I do think that knowing how to use those tools effectively and creatively to find answers that are useful and impactful to our patients and students is a significant long-term advantage.
What advice do you have for aspiring medical educators?
The educationalist is a relatively new path, and there may not be a paradigm established in every institution. To some extent I created my own path in this career, for which my experiences teaching anatomy, organ-based pathology, the MCAT syllabus, and working for Kaplan were invaluable. I would recommend getting experience wherever you can to help develop and hone the required skills.
Generally, a sense of audience really helps. You might be the leading expert in your field, but can you explain your specialty to a group of first-year medical students in a way they can understand, based on their knowledge base? Whether I'm teaching the same content to first-year medical students, graduating fourth years, or residents, or delivering a talk at a conference, I’m always careful to adjust the tone accordingly. What do the individuals already know? What do they not yet know? What will they be learning in the near future? How do I build that sense of interest based on the current level they're at?
Attention to detail is also important. I've seen incredibly detail-oriented pathologists who can spot that one lesional cell on a slide but don’t manage to translate that level of attention to their educational materials.
In terms of delivering educational materials in the most effective way, it's really important to be open to feedback from students – and to be introspective and iterative in how you act on it.
Finally, there is plenty of literature and e-learning available on the general principles of education, the science of instruction, and instructional design. I would advise exploring those resources to gain an understanding of the types of educational models available and the philosophies behind them.
How has your research into color vision deficiency (color blindness) helped shape your institution’s accessibility policies?
Color vision deficiency is relatively common; according to statistical studies it affects one in 12 males and 1 in 200 females. The subjects that I teach – anatomy and pathology – are highly visual, and we are somewhat reliant on color-related language and color-coded diagrams to teach them; for instance, red denoting decreasing, inhibition, or worsening, and green indicating increasing, stimulation, or improvement. These differences may not be detected by all learners with color vision deficiency.
I’m someone who used to use a lot of color-coding when studying and building resources for myself, and I naturally assumed that providing these organizational tools to students would be helpful. But, over time, students would occasionally approach me to explain that, while they loved my approach, they couldn’t distinguish the colors I used in my materials due to colour vision deficiency. That led to me doing a deep dive into the issues, and producing a best practices guide for educational materials, which now sits with our Office of Accessibility Services and is used across many disciplines, not just in medical education.
Currently, a group of medical students is reviewing the educational resources from our entire curriculum to find instances where learners with color vision deficiency may be at a disadvantage, so we can address and manage these inequities. We need to make the learning accessible to everyone.
Before medicine, you studied music. What role does music play in your life now?
It’s a source of right-brained joy in an otherwise very left-brained world. I was a clarinetist growing up, I play piano, and I sing. I’ve been fortunate that a number of institutions I’ve been at have had musical organizations. The place I did my residency had its own orchestra, and Jefferson, where I am now, has a chorus.
Participating in those groups has been a good opportunity to join a community, meet people from different departments, and to create joy around an art form.
I’m fortunate to have one of the preeminent orchestras in my home city of Philadelphia, whose concerts I enjoy attending. It’s also nice to be able to listen to a Mahler symphony on my commute home, or play piano in the evening to blow off a little steam. When you allow music to wash over you, it relaxes the brain and the body, opens creative thought pathways, and offers a reprieve from day-to-day thinking.
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