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Outside the Lab Training and education, Profession

Visual Aids in Medical Education

The study of the body’s pathologies is one of the most challenging – and important – parts of becoming a physician. Not only is this knowledge critical to the diagnosis and treatment of patients, but it is also an almost sacred centuries-old ritual in which the physician-educator teaches the student until that student becomes a physician-educator for the next generation. Or, in the words of Hippocrates, “I will love those who taught me these arts as I love my parents, and I will offer my skills to the young with the same generosity that they were given to me. And I will never ask them for gold, but demand that they stand by this covenant in return.” Though the modern-day medical-industrial complex often seems to have forgotten the latter sentence, the sentiment still rings true today. Scores of doctors came before us and learned many of the same concepts we learn today – although technological advances have given us the advantage of much greater scientific depth.

Some students thrive in learning this mass of information medicine calls “pathology,” immersing themselves in the cellular and molecular world of each organ and tissue – but, even for those who don’t, basic mastery of the material is a key part of becoming a physician. However, as medical schools shift their curriculum to a more patient-centric approach and shorten the preclinical years, the vital science and art of pathology is being lost. This not only poses a risk to the field of pathology, but also carries as-yet unknown consequences for the future of patient care.

The “a-ha!” moment

As a medical student interested in both pathology and medical education, I found my preclinical years challenging, but also eye-opening. While students are submerged in the depths of pathophysiology and pharmacology, there are countless opportunities for educators to share common “a-ha!” moments that make the continuous stream of complex information click – so why doesn’t this happen?

In many senses, these “a-ha!” moments have been articulated in long form in textbooks – but the information in these, and in the numerous extramural resources students are pressured to use, is massive. It is impossible for students to read and digest it all, let alone make these final crucial connections, before the class moves on.

Comprehensive resources such as Pathoma share a great deal of “a-ha!” moments and cross-system connections, but there are still untapped opportunities to bring pathology to life – and this is where visual aids, short videos, and flash summaries come into play.

Seeing is believing

When I first dipped my toe into visual aids, I was trying to summarize a whole section of microbiology into a single figure. This type of figure, which I call a summative image, is helpful for exam review, but – because it is dense and has a large amount of text – is not a great way to inspire people to engage with the material or make a complex idea more digestible. As I continued to develop content for #MicroMedEd, I found that visual digital communication was a suitable and effective medium for communicating both pathology concepts and clinical topics in diagnosis and treatment. And, as I furthered my training through the Digital Communications Fellowship in Pathology, I started codifying my thoughts to help others communicate pathology education visually and virtually.

In doing so, I have developed a few categories into which visual aids could fall and the purposes for which they could be used. I have already mentioned the summative image but, in addition to this large and cumbersome type of imagery, other categories that I have formulated are: i) thematic chunking, ii) clinical correlates, and iii) side-by-side comparisons.

Thematic chunking

This type of figure takes a set of diseases with very different pathogenic mechanisms and connects them with a smaller set of pathologic themes (see Figure 1). In making this figure, I found that, instead of studying each disease entity alone – as one typically does with flashcards or spaced repetition software – providing the learner with a more simplified set of trends or themes allows them to focus on understanding what pathology means and how to apply its core concepts to the specific entities within the umbrella category. For instance, this figure takes obstructive lung diseases and defines the term up front, immediately answering students’ most common question. Next, it illustrates the different mechanisms (themes) by which the clinical end result is observed. This method can be expanded to include process/flow imagery to help students connect the dots from physiology to pathophysiology and histology to patient presentation.

An infographic on the topic of obstructive lung disease that uses the “thematic chunking” method to break the condition down into its different forms (such as bronchiectasis, asthma, or emphysema) and the different pathophysiological causes of each form (such as mucus plugging, inflammation, or tissue destruction).
Figure 1. A “thematic chunking” visual aid that breaks down the mechanisms of obstructive lung disease.

Clinical correlates of disease

Though pathology is the foundation of modern medicine, students often get stuck in the minutiae and feel disconnected from the patient on the other side of the disease process. This is where patient presentations and clinical tests can come together with the histologic findings to form a story the student can follow (see Figure 2). To emphasize the bridge between clinical testing and pathology, this figure attempts to ground an understanding of complex clinical test results in pathology and pathophysiologic concepts. Here, the bridging of these two worlds, combined with pattern recognition, will hopefully help students better tackle these often-missed questions.

An infographic on the topic of pulmonary function tests that illustrates the different flow-volume loops seen in spirometry and links these with different disease processes (such as small and large airway obstructions at different locations in the respiratory tract).
Figure 2. A visual aid that shows clinical correlates of disease – in this case, linking test results with causative disease processes.

Side-by-side comparison

When students are faced with a clinical vignette (either in person or on a test), they often want to know how to differentiate between pathologies with similar presentations. This is where classical medical education typically fails. In classical medical education, the pathologies are taught system by system, with classes of pathologies grouped together using common pathologic diagnostic criteria. Though this is a great heuristic for learning the pathophysiology and associated histologic findings, students often get stuck on clinical vignettes early in boards preparation because they can’t escape systems-based thinking to develop complex multisystem differential diagnoses. This is where my interpretation of side-by-side comparison departs from most tables found in textbooks and review resources.

I like to use the side-by-side comparison for similar patient presentations that involve different pathologic processes or even different systems (see Figure 3). Though pleural effusions are relatively easy to understand, I found that they were taught in so many different blocks that I had difficulty remembering them for comparative purposes. For instance, students may learn about parapneumonic effusions in bacteriology, amoebic and Aspergillus effusions in parasitology and mycology, hemorrhagic and transudative effusions in cardiology, chylothorax in gastroenterology, and pseudochylothorax in rheumatology. Instead of fighting to remember each of these unique findings from various areas of your medical training, why not put them all in one place to better formulate a broad differential diagnosis when there is a pleural effusion on a patient’s chest X-ray? Though this is not the most “visual” of aids, it also takes a strictly clinical presentation and links it to the laboratory medicine of the diagnosis through microscopy and sample collection.

An infographic that compares different pleural effusions based on type, fluid color, pathogenesis, microscopy, and treatment to support differential diagnosis in the clinic.
Figure 3. A side-by-side comparison linking different types of pleural effusions that may originally have been taught in different blocks.

Summative imagery

As mentioned above, summative imagery is not ideal for presenting material to a learning audience, especially when trying to inspire or engage students. For this reason, it is not one of the three main strategies I use when making figures. Nevertheless, it can be extraordinarily helpful when studying for exams or boards, when students want to see a whole class of pathologies in one image. When done well, summative images can be useful review resources that make complex collections of pathologies or concepts more manageable by offering a “bird’s-eye view.” (Just be careful not to include so much information that the image becomes overwhelming!)

There are many wonderful examples of these images on GrepMed, a crowdsourced medical education resource that hosts thousands of high-quality algorithms and summaries by students and educators from around the world.

Emerging media in medical education

In addition to the visual aids I’ve discussed, there are numerous phenomenal examples of #MedEd virtual communication strategies, from short videos discussing pathologic diagnoses to long-form explorations of complex or emerging topics. After immersing myself in the world of digital communications during my fellowship year with @DCF_path, I have learned about the complexities, challenges, and benefits of each method. Above all, I learned that innovative teaching methods and communication tools are enthusiastically adopted by the pathology community. Though the community’s high degree of involvement in medical education makes this unsurprising, I find it reassuring that this vital specialty continues to evolve and adapt to the ever-changing landscape of medical education so that it can remain relevant, important, and inspiring to future generations of physicians.

The drive behind innovation in digital communication is to help students better understand the field of pathology and, hopefully, make them better physicians. Often, visual communication takes a great deal of time and energy, as well as a creative mind and the ability to look at a familiar topic with a fresh set of eyes. This is where collaborations and interprofessional communication on social media platforms can help; creators can seek immediate feedback and form meaningful professional connections for possible future collaborations. Illustrations are also a great way to pass down clinical pearls that might help other students in future. These types of personal touches make each educational resource unique – and, in terms of social media and branding, can help the illustrator/educator develop a professional identity.

Finally, these are just three ways I like to think about illustrative education; the possibilities are, of course, unlimited. In a perfect world, a single image could illustrate the process, presentation, and differential all at once – but, when using static images, clean and sleek designs help you communicate effectively and generate visually appealing communication aids that catch the attention of your current and future colleagues.

Disclaimer: all figures were made using BioRender.com. I am not reimbursed by BioRender in any way and am not using this platform as a means of promoting their software.

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About the Author
Cullen M. Lilley

MD/MA candidate at Loyola University Chicago Stritch School of Medicine, Chicago, Illinois, USA.

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