Why the need for change?

Students learn pathology from diverse formats - Pathology leads the way

To make room for student directed learning all disciplines that were taught in the first three years were required to reduce lecture content by about 25%. In view of the fact that our department’s pathology teaching was divided into core and special topics which were optional, the core material became the basis for the lectures in the first 2 years of the curriculum. Students are still taught the principles of pathology as well as basic systems based pathology.

We also recognized that instead of relying on teaching per se, the emphasis should be on enhancement of learning of pathology and from diverse formats – lectures, practicals, computer assisted learning sessions, laboratory visits, structured displays, PBL tutorials (see below). We ensured lectures (large group teaching) and practicals had key learning objectives so that students would not only grasp key concepts but would be able to apply them in understanding the pathogenesis of diseases and approaches to diagonosis. We designed these learning sessions to be as interactive as possible with students doing much of the questioning and clarification.

The Department of Pathology has many teachers holding positions of leadership in undergraduate medical education who have played key and pivotal roles in the design and implementation of the new curriculum, particularly in the design of new tutorial cases in every module and in the introduction to health and disease blocks. As medically qualified graduates we are in a key position to see the overall picture of pathological science in the curriculum and work with basic science faculty to translate this into meaningful cases. As part of professional development, members of our department have also attended overseas medical education courses and have been recognized as excellent teachers by awards of Faculty as well as University Teaching Fellows.

PBL – one component of a new curriculum –is an important educational process for life long learning

Before the Faculty introduced small group problem based learning (PBL) in 1997, our department in fact was one of two which considered PBL as a teaching methodology. PBL tutorials are different from those that alumni might have experienced when learning pathology at HKU before 1997. Formerly the tutor was a content expert. In the new curriculum of the Faculty, the tutor may NOT be a content expert but is provided with a guide, written by a content expert, which allows him or her to gauge how the group is progressing through the factual material. Unlike the old style tutorials, the PBL tutor is also concerned that the group is working as a group and the process of learning is just as important, as the factual outcome. Staff need to be aware that facilitation involves:

• Empowering all students to take responsibility for their learning
• Managing discussions but not providing information
• Intervening only when necessary to ask questions to focus or stimulate the discussion
• Discussing the concept of resources and how they should be used
• Assisting students to learn to work co-operatively as a group
• Providing strategies for conflict resolution

Intern review and assessment have shown that the new HKU graduates appear better at working as a group and learning for themselves.

Within our existing curriculum we have pathology lectures and practicals which are totally dedicated to pathology teaching. In the more advanced years our department members liaise with clinical teachers in combined teaching sessions and we act as resource faculty for many areas.

What improvements did we make to the final years of the curriculum?

We have now introduced additional teaching sessions: structured displays are case scenarios that highlight for the student the role of the pathology laboratory for the clinician working in the hospital setting. In addition we have placed greater emphasis on molecular pathology and its importance in diagnosis. Below is an example of a structured display:

Special Study Modules have generated great interest, especially in the field of forensic pathology. Students in their final years of the curriculum can also “shadow” the pathologists in their routine surgical pathology diagnostic laboratory activities, so that they are better able to appreciate the importance of pathology and as graduates will be more aware of the subspecialties of the Hong Kong College of Pathologists.

And the autopsies

Yet again, to make time for students to learn we have reduced autopsy teaching during the year. Now, students are scheduled to visit a public mortuary with their group where they observe autopsies, and learn about gross pathology and the system of death investigation and certification in Hong Kong. In line with the self-directed learning philosophy, students may avail themselves of the option of autopsy attachments during the special study modules which are held over the summer months.

Changes to assessment

We have changed the assessment system so that students no longer write long essays for the yearly exams but instead are set multiple choice and short answer questions. This allows for a greater area of knowledge to be assessed in a more objective way. The Department of Pathology is also intimately involved in the planning and factual input of the curriculum and most members of staff are either course coordinators or planners in the Undergraduate Education Committee or the Institute of Medicine and Health (IMHSE). We have also changed many of the existing practical sessions to make them more case based.

Looking to the Future

Senior students are now distributed in many allied hospitals where honorary teachers have a valuable role to play in offering teaching sessions, options to see cut ups, and clinical-pathological meetings. Laboratory attendance of these senior students enables them to better appreciate the importance of the diagnostic pathologist to patient care and the direct contribution of the pathology profession to medical care. We continue to endeavor to seek ways to improve the image of the pathologist in the eyes of the general public, finding opportunities to make them better aware of the contribution of our expertise toward many aspects of the medical profession.