This group was asked to discuss the most immediate and major problems in teaching pathology at our respective institutions. The number one problem that was immediately identified was the decreasing availability of pathology teaching faculty. One major difference between the discipline of pathology and the other basic science disciplines is the service requirement of the former. With the accumulating pressures placed upon the medical system, the service responsibilities of the pathologist continue to increase. The consequence of this is that there are fewer hours to teach medical students in the classroom and, also very importantly, fewer hours to prepare for that teaching, thereby resulting in a decrease in both the quantity and quality of pathology teaching. This situation has also been exacerbated by the relative lack of recognition or reward for teaching at many medical schools. Our international participants stated that this decreased availability of teaching faculty was not confined to the United States and, in fact, may be much more severe in some of the less developed countries. The second problem discussed was the apparent decreased turnout of physician-scientists or academicians. We discussed efforts to encourage students to pursue a career in pathology and, more particularly, a career in academic pathology. These include funding post-sophomore fellowships (essentially sub-internships), offering pathology electives in the clinical years that give students an opportunity to model the profession, and making an effort early in the basic science years to identify and nurture those students displaying an interest in pathology. A third problem identified was the marked decline in the use of the autopsy in medical and continuing education. Despite the many changes that have occurred in the way medicine is practiced, the autopsy still offers great potential opportunities for the education of medical students (as well as physicians and others in the health care professions). These include, for example, correlating physiologic and pathologic processes with anatomic structures, understanding medical uncertainty and the significant discrepancies that often exist between clinical and autopsy diagnoses, learning to correctly complete a death certificate, and appreciating the role of the autopsy in the quality assurance program of the hospital. However, deep, and long-standing problems continue to contribute to the declining autopsy rate and threaten its survival at many medical centers. This has resulted in many medical schools being forced to drop the autopsy experience from the curriculum. The physicians graduating from these programs then do not fully appreciate the importance of the autopsy and do not seek permission from the next of kin for autopsies on their patients who die, thus contributing to the continuing decline of the autopsy. There was general agreement that these discipline-based round table discussions are a valuable addition to the IAMSE meetings and should be continued, but would be greatly enhanced by making each group interdisciplinary. This would provide the opportunity for each discipline to more fully understand the goals and difficulties of other disciplines and perhaps lead to a more cooperative approach towards achieving a truly integrated curriculum. Participants: Charles Hitchcock, M.D., Ph.D., Joseph Grande,
M.D., Ph.D., Thomas Arnold, Radim Licenik, Georgette Dent, M.D., Ramon
Hugo Martinez
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