Guidelines for Studying Images in Pathology

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Guidelines for Studying Images in Pathology

• Virendra Jaiswal, Bharti Bhusnurmath, Shivayogi
  Bhusnurmath
  
• St. Georges University, Grenada

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SITUATION

• All students in pathology need to study images
• Kodachromes, glass slides, digital images,
  picture in books.
  
• Gross specimens, microscopic images, EM, Immuno,
  Imaging studies
  
• Teachers explain/text description ? students
  memorize

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WHY STUDY IMAGES

• Tested in exams.
• Visual basis for understanding disease process.
• Extrapolate to a patient to explain clinical
  features, investigations and outcomes.

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USUAL METHOD

• Memorize the image and the diagnosis
• Problem Encounter a new image in exam/real life
  
  
• May not analyze/diagnose correctly

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AIM

• To develop a method/protocol
• Students learn to analyze an image independently,
  logically, scientifically and arrive at
  conclusions
  
• Under supervision
• So that they become independent and life long
  learners
  
• Advantage future board exams, clinical
  situations

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METHOD

• Discussions within the department faculty
• Thought processes in our minds when we as
  pathologists see an image
  
• Task analysis steps involved listed
  (protocol)
  
• Prescribed to students
• Supervised their self analysis
• Studied outcomes of this learning protocol

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PREAMBLE

• The image represents a patient
• Think of the patient all the time
• Fit the image in that context

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STEPS IMD

• Identify organ/tissue based on anatomy/histology
• Morphologic features that are different from
  normal
  
• Diagnosis of disease based on altered structure

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STEPS EPS

• Etiology explain the etiology
• Pathogenetic mechanism explain
• Structural changes
• If it is a gross specimen what would be the
  histology
  
• If it is a histology what would be the gross
• Are there any other sites of involvement?
• Are there any other diseases where similar
  changes seen how to distinguish?

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STEPS - SI

• Symptoms signs develop these based on the
  structural alterations
  
• Investigations that can be done to
• a. confirm the diagnosis
• b. determine the extent of disease
• c. any other diseases where they are
  positive - how to distinguish

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STEPS - CVQ

• Course of the disease outcomes, complications
• Vignette develop a clinical vignette for this
  disease
  
• Questions develop 2 -3 questions that can be
  tested on this image

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IMD-EPSSIVC

• Not all may be relevant for each image
• Systematic study of these lines helps reach
  logical conclusions

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RESULTS

• All students (320-340) follow this protocol
• Each student prints out the stepwise analysis for
  the group posted on course website
  
• Exams 95 images tested with 190 test items (out
  of total 450) about 50 images from external
  sources excellent results
  
• Anecdotal feedback from students after USMLE
  Step I felt like all images were lifted from
  our lab manual

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SUMMARY

• Active learning by students to analyze any
  medical image and derivation of clinical
  correlates.
  
• Teach them how to cook and they will feed
  themselves for the rest of their life.