Pathology in Medical School Education: The Cornerstone of Medicine
Dr. Barbara Ritschel discusses the value of pathology education at USU.
 |
| USU’s pathology curriculum is interdisciplinary and taught in an innovative manner using integrated small group sessions, problem-based learning, team-based learning, and recorded lectures. (Photo courtesy of Dr. Barbara Ritschel, USU) |
December 26, 2024 by Vivian Mason
Pathology is the backbone of medical education, the bridge between basic science and clinical medicine. It focuses on determining the cause, origin, and nature of disease. Testing and analyzing body tissues, organs, and fluids enable healthcare professionals to diagnose and treat patients correctly. For example, all patients with oncologic diagnoses and the majority of patients with cardiovascular disease require laboratory testing. Pathology underpins every aspect of patient care. Autopsies also help us understand the disease process, the natural history of disease, as well as the effects of treatments.
 |
Barbara Ritschel, M.D., vice chair of pathology education, and professor of Pathology and Emerging Infectious Diseases in the Department of Pathology at USU’s School of Medicine. (Photo credit: Tom Balfour, USU) |
“As physicians,” Ritschel continues, “we diagnose diseases and disorders day in and day out. We also want to help patients stay well. Knowing the disease mechanism is really central to being able to understand why it’s presenting a certain way in a patient, and what mechanistically has gone wrong, as this may drive the selection of treatment.”
Medical students at USU learn about the underlying mechanisms of diseases that are essential for accurate diagnosis and effective treatment of patients. A sound grasp of pathology is required in all areas of clinical practice. Studying pathology helps make medical students better physicians by helping them understand disease processes, knowing which laboratory tests to order, the advantages and limits of diagnostic modalities, and how best to approach diagnostic information in clinical practice.
Ritschel oversees all pathology education throughout the four years of medical school. USU students are introduced to pathology through various laboratory, small group, and team-based learning sessions integrated into the seven pre-clerkship modules. The goal is to prepare students for their clinical years and beyond.
Throughout the pathology curriculum, key aspects of pathobiology and applied pathology practice are integrated into a program that includes disease mechanisms and processes, organ system pathology, and diagnostic medicine and therapeutic pathology. Most pathology education at USU occurs during pre-clerkship (the first year and a half of medical school). Students are given an opportunity to enhance their knowledge and obtain a greater understanding of the pathological basis of disease.
In pathology, there’s also a comprehensive publication, The Pathology Competencies for Medical Education, that was updated in July 2023. It consists of competencies, goals, and learning objectives deemed important for all medical students to know. USU’s curriculum, like others around the country, is built on these learning objectives.
These competencies were developed as a national resource of expectations of pathology knowledge for medical students. They are composed of three major competencies: disease mechanisms and processes, organ system pathology, and diagnostic medicine and therapeutic pathology.
“Initially,” says Ritschel, “a group of about 60 pathology chairs and course directors from across the United States met and pooled together all of our learning objectives. Then, we went through those to decide what the majority thought was essential for medical students to know.”
Pathology knowledge is closely tied to clinical skills. Good clinical reasoning grows from a solid understanding of pathology and how diseases and disorders present. What is most important is that students understand pathology’s impact on clinical reasoning. This, in turn, plays a key role in creating physicians who think logically and scientifically when diagnosing and managing their patients—ultimately improving patient care. Exposure to a foundational pathology curriculum gives medical students the framework to think about how best to use the information in clinical practice.
There are common misperceptions about pathologists—that they don’t do patient care. “We run into that all the time,” says Ritschel. “Pathologists are key to patient care because we’re driving the diagnosis. We may not be in the examination room with the patient, but we are key to patient care by making sure the patient has the right diagnosis at the right time.”
Ritschel continues, explaining that pathologists also run the clinical laboratory and do all of the laboratory testing. “For the doctor,” she says, “it’s really about understanding and knowing that the tests you ordered are giving you the correct results. Those tests have to be interpreted within the context of the patient.”
Understanding how pathologists diagnose conditions and how clinical pathologists support lab diagnostic testing enables students to know who to contact with questions when they rotate on the ward or take care of patients.
Medical students have to take the USMLE (United States Medical Licensing Examination). It consists of three exams or steps, with Steps 1 and 2 taken while in medical school and Step 3 taken during the first year of internship or residency. On the Step 1 exam, approximately 50% of the questions are pathology related. This underscores the importance of understanding disease processes and mechanisms for keeping patients safe, as well as how treatment can affect or change the disease process.
Pathologists can focus on an organ system in surgical pathology—such as neuropathology, gastrointestinal pathology, or gynecologic pathology—or they can specialize in blood banking, molecular pathology, or forensics. “In USU pathology education,” notes Ritschel, “we focus on disease processes. In patients, especially those with cancer, the diagnosis is made by the pathologist. This specialist obtains the genetic and genomic testing and studies that are pertinent to appropriately subclassify and stage the disease. This allows the patient to receive the most precise and optimal therapy.”
“For example, it’s important to know exactly what type of lymphoma a patient has and the molecular changes in those tumor cells. This may alter the prognosis as well as the treatment for that patient. If a patient has a specific molecular mutation in the cancer cells, we may be able to treat it with targeted chemotherapy or immunochemotherapy that may have fewer side effects than broad chemotherapeutic agents. This in turn would most likely increase the patient’s quality of life during and after treatment.”
Ritschel oversees the entire pathology curriculum at USU, which includes innovative interdisciplinary teaching methods, such as small group sessions, problem-based learning, and recorded lectures. The goal is to instill an understanding of disease mechanisms, diagnostic processes, and therapeutic approaches in medical students. As a result, USU students are well-prepared for both their clinical years and their future careers.
“As a pathologist and a leader in pathology education,” says Ritschel, “I chose pathology because it’s fascinating and challenging. There is so much more in testing and what we know about disease processes than when I started in pathology decades ago. It’s great to be on that cutting edge of knowledge and diagnosis every single day. We can never forget that every slide or lab result we evaluate is for a patient and is an important part of their care. Patient care is central to everything we do.”
