Simon Nazaretian^1,2, Jim Hsu¹ and Bruce Waxman¹  

¹Monash University, Faculty of Medicine Nursing and Health Sciences
²Alfred Pathology Service, Alfred Health.  

'Declarations of interest: none'.    

'Artificial intelligence has not been used in the preparation of this manuscript' 

Introduction: 

“To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all”: Sir William Osler. (1)
Hugh Arnold Freeman (1925-2011) was foundation Professor of Surgery at the then newly-established Monash University, Victoria and was based at the Alfred Hospital. 
He reinforced clinicopathological correlation (CPC). Bruce Waxman continued these sessions in the 1990s while Simon Nazaretian was one of his medical students. We have again reinstituted these sessions and aim to instill a passion for understanding the pathological basis of disease. 

Methods: 

CPC provides an effective tool of collaboration and cooperation of interdisciplinary learning and discussion on problem solving. Another achievement is good clinical practice ultimately gained from CPC presentations. Audience participation is difficult particularly when presenters need to monitor hundreds of students online. Encouraging participation can be difficult. (1) CPC sessions lend themselves to problem based learning (PBL) where students acquire knowledge by devising solutions to problems as they do when devising a list of differential diagnoses to a clinical scenario. (2) Teachers are facilitators of this process. (3) The Monash University School of Medicine has pathology as part of the third year curriculum. Pathology is taught in two parts, initially as an introduction to basic process including cellular adaptations, cellular injury, inflammation with tissue responses as well as neoplasia, and then as systematic pathology. The CPC sessions link to one or more of these topics. The clinical information is presented by the clinician, which includes the history of the complaint and the examination findings. This is followed by a discussion of types of investigations that may be performed and subsequent results. These discussions would be very much suited to interactive involvement of students. However, as these sessions are pre-recorded, our only way is to present these findings in a way that allows the student to enter the mind of the presenter and understand how we formulate lists and differential diagnoses. Pathology is introduced by how the specimen is taken and how it should be sent to the laboratory. The pathologist discusses preparation of the sample and interpretation of results. It is vital that during the macroscopic and microscopic demonstrations, pathological findings are linked to clinical findings and thus used to explain symptoms and signs. 

Conclusion:

This framework is applied to CPC sessions across the broad range of pathology specialties including anatomical pathology, haematology, biochemistry, microbiology and genetics. The challenges for pathology educators are to ensure students understand basic pathological sciences and students can apply this knowledge clinically.

Educators must achieve these goals with less teaching time afforded to them by medical institutions, with fewer opportunities for face-to-face teaching and having larger cohorts of students who are spread across multiple, including many remote, sites.  Educators are encouraged to promote the pathological sciences, teach pathology and its importance to professional practice and clinicopathological correlation sessions provide that vehicle. 

References: 

(1) Jain S. Clinico-pathological correlation: Teaching aspects, avenues, and advances. J Adv Med Educ Prof. 2022;10(1):59-63. DOI: 10.30476/JAMP.2021.89846.1387 

(2) Hassan S. About Clinicopathological Conference and its Practice in the School of Medical Students. Malaysian Journal of Medical Sciences. Vol. 13 (2). July 2006: 7-10.   

(3) Australian Online Courses. Educational Psychology, Course Code: BPS105. 2022. https://login.training/members/Courses.aspx?cid=3287.