Incorporating NEJM “Clinical Problem Solving” into a medical school pathology course

INCORPORATING NEJM “CLINICAL PROBLEM-SOLVING” INTO A MEDICAL SCHOOL PATHOLOGY COURSE

Scott J. Schoenleber*, David M. Kurtz, Jennifer L. Kruse, Joseph P. Grande, MD, Ph.D. Mayo Medical School, Mayo Clinic College of Medicine, 200 1^ST Street SW, Rochester, MN 55905 U.S.A.

PURPOSE: Integration of the basic and clinical sciences has become a priority in medical education. An introductory pathology course emphasizing morphologic changes and mechanisms of disease in lecture- and case-based formats would be an optimal environment in which to combine these.

METHODS: We developed a clinical problem-solving journal club to provide students with a framework for formulating a differential diagnosis and considering diagnostic tests. Upon course completion, students were given a survey to report their thoughts regarding the benefits and shortcomings of journal club.

RESULTS: Forty-one of 42 first-year students completed the survey, which contained questions scored from 0 (strongly disagree) to 10 (strongly agree). Students were split regarding journal club’s value (24% rated it as “very valuable;” 44% rated it as “least valuable”). The greatest benefits of journal club appear to be correlating clinical cases with pathologic findings (mean score 7.0/10), formulating a working differential diagnosis (6.6/10), and becoming more excited for upcoming clinical experiences (6.5/10). Students who found case-based learning useful also reported journal club to be a useful way of making clinicopathologic correlations (p=0.05). Those who said journal club was a most useful part of class reported large improvements in differential diagnosis formulation (p=0.007), a greater desire to read medical journals (p=0.002), and more excitement for upcoming clinical experiences (p=0.003).

CONCLUSIONS/FUTURE DIRECTIONS: A journal club emphasizing clinical problem-solving may be a useful tool in a case-based and basic science curriculum. Focus on differential diagnosis formulation and clinicopathologic correlations appears to be most enjoyable and beneficial.