Modernize Your Mindset

We need to drastically overhaul the way we teach pathology to medical students in India. As teachers, most of us do to our students what our teachers did to us. Our teaching is largely geared toward specific facts about specific diseases. For instance, we describe the morphological characteristics that help us make diagnoses – but we don’t explore how these diagnoses affect our patients. What signs and symptoms do they produce? Why do we choose certain lab investigations over others? How do the tests we perform help to establish the diagnosis, etiology, extent of disease, or potential complications? Have we chosen the least invasive, most affordable testing options? Does the diagnosis leave anything unexplained?

Questions like these emphasize the role of pathology as the foundation of clinical medicine. Students are excited to study diseases in context instead of passively memorizing the details of morphologic changes to pass exams. In my view, we as teachers do a great disservice to medical students when we force them to memorize instead of teaching them how to apply pathology in a clinical context. Rather than teaching “pathology,” we should view ourselves as teaching “clinical reasoning based on pathology.” That approach promises to yield logical, science-minded doctors and improve healthcare. After all, our goal is not to make every medical student a pathologist; only a small fraction of each class will choose to pursue our discipline. It’s more important to show them pathology’s vital role in understanding every aspect of a patient’s problems and identifying the best approach to management.

It’s also important to abolish the outdated perception of our role as teachers. We’re not here just to pass on the details of our knowledge; our lecture notes, textbooks, and online resources can provide those. Our job is to develop interactive lecture and lab sessions in which students interpret and analyze clinical scenarios and use pathology information to make decisions. Moving students from passive listeners to active participants can take many forms – “clickers” for responding to multiple-choice questions, concept mapping, modified essay questions, flipped classrooms, team-based learning, writing clinical vignettes based on unknown pathology images given to them, and more. It’s amazing how well students rise to the challenge if we create platforms like this to spark their intellectual curiosity.

But medical expertise isn’t all we have to share. We need to incorporate learning objectives on professional behavior and communication skills for both medical students and residents – and residency training should include a component on business practices in pathology. In India, most of the emphasis in residency training is on surgical pathology, but only a few go on to practice as surgical pathologists. The bulk of practice for most is clinical pathology, which receives little attention during residency training.

Continuing medical education (CME) in India is more like a wedding ceremony than a learning environment. High-level academics are invited to speak about their work and surrounded with celebrations – but no effort is made to determine the target audience, their knowledge level, or their educational needs. There are no measures to determine the impact or sustainability of the CME. The general refrain of residents and junior faculty is that the topics discussed often have no practical utility for them – and yet the costs are high to subsidize the speakers’ travel, accommodations, and entertainment. Why not use online tools to give lectures, slide seminars, or even interactive sessions that interested audiences across the globe can access at a low cost? Events could be held at convenient times, repeated, or archived and made available on demand. The stumbling block? Faculty reluctance – because we have created an environment where physical appearance and celebration matters. We need to set our egos aside and work for the greater good if we want to create effective, meaningful CME.

The Indian mindset toward pathology education needs to change – from our medical students’ first introduction to the discipline all the way to professional development for senior pathologists. Only when we are willing to move out of our comfort zone and grow as educators can we provide world-class training to all pathologists in India.