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The former degree is used as foundation for additional graduate studies eg, MD or PhD or for positions in basic and translational clinical research. Applied Biosciences is a 2-year course of study designed to prepare students to competitively enter the scientific workforce, applying the biological sciences to solve problems faced by public institutions and private industry.

The PATH faculty members found that weekly, 2-hour, pathology laboratories could be taught to a diverse student body, including students coming into the course with little knowledge of biology, chemistry, and histology. We avoided creating any course prerequisites. As an example, we reviewed the gross morphology of the heart in relation to the pulmonary and systemic circulations. Therefore, the absence of traditionally required preparatory coursework was not an impediment to performing well in the course.

Some revisions to the PATH course were made over the years in response to advances in medical science, in education technologies, and to changes in department faculty composition. As an example of advances in medical sciences, a lecture on genetics was revised to cover present methodologies in molecular medicine and discoveries made as the result of subtyping lymphomas based on gene signatures. Major changes in response to advances in teaching technologies were the replacement of light microscope histopathology slides with whole slide images and gross pathology specimens with 3-dimesional photography images.

The PATH course is taught in College of Medicine classrooms and began using digital pathology technology shortly after it was implemented for medical students. In their PATH course evaluations, the graduate students commented favorably on the effectiveness and convenience of using whole slide images. The students noted that having access to the images outside of the laboratory, through Web-based programs, was particularly useful. In response to this comment, we reduced the total number of instructors in the course.

This was achieved by having the general pathology part of the course taught entirely by just 2 faculty with new faculty coming in assigned to systems pathology lectures. Furthermore, when faculty who had taught system pathology lectures moved away, these lectures were reassigned to the 2 faculty members who gave the general pathology lectures. Our goal was to have the number of faculty reduced to just 3 or 4. For this introductory course, our surgical pathologists and autopsy pathologists were prepared to give lectures on several organ systems each.

This resulted in a large segment of the population having no exposure to pathology education. It is noteworthy that the Flexner Report was published at a time when medical doctors represented nearly half of the health-care workforce. The other half consisted mainly of licensed practical nurses. Registered nursing programs were barely on the radar screen.

The German university model had been successfully implemented at only a handful of US medical schools before that time, a century ago. Flexner 2. Today, the makeup of the health-care workforce is very different than it was a century ago. DC Baldwin, personal communication, This may directly impact on the scope of team training in clinical practice. Conversely, by broadening the base of students who have prior knowledge of mechanisms of diseases, the range of topics suitable for interdisciplinary team training is expanded as well.

Today, the Flexner Report recommendations can be linked to the underrepresentation of pathology coursework on mechanisms of diseases in nursing schools and pharmacy schools as well as many other categories of health education programs such as the allied health sciences.

On the other hand, what is now becoming apparent is that the century-long exclusion of pathology as coursework for the vast majority of US students, at all levels in the education system, inadvertently created a level playing field for the introduction of pathology to large segments of the population today, a previously unanticipated opportunity from the perspective of health education research.

Now, having been partially freed of the Flexnerian premedical science coursework requirements, biology, inorganic and organic chemistry, and physics, which were in place for a century but are now beginning to fade in popularity, greater flexibility exists for curriculum planners with regard to identifying and justifying their preferred grade levels for the inclusion of pathology courses in a broad spectrum of science curriculums. In this study, we have now tested the feasibility of introducing pathology coursework at the upper end of the education spectrum, by teaching such coursework to MS and PhD students drawn from 21 different graduate programs, in the physical and biological sciences at a research university.

Having shown that medical science can be taught at multiple levels throughout the education system, without prior student exposure to the traditional premedical sciences, serious thought should be given to preferentially introducing such pathology coursework at grade levels on which it would have the greatest positive impact on the health and welfare of the general population.

Our finding that PATH was especially attractive to MS students is noteworthy given that MS degree programs are rapidly proliferating on university campuses today. Academic pathologists interested in public policy should be encouraged to become involved in creating an inclusive national vision for medical science education for nonphysicians in order to increase public awareness concerning the broadening of opportunities in the health-care industry and the benefits of personal knowledge about the nature of diseases as active participants in their own health care.

The authors wish to thank Dr William Bellamy for his invaluable contributions in the first years of the course and Lynne Richter and Robert Hershoff for their expert technical assistance. The objective of this course is to provide graduate-level instruction in pathobiology: the study of biochemical, structural, and functional changes in cells, tissues, and organs, which cause or are caused by diseases. The course is designed for graduate student training for a career in biomedical research.

The course also provides a foundation for understanding the medical science literature. Modern pathology is practiced as both a clinical and an investigative science. Clinical pathology assists in disease diagnoses based on the observed changes in tissue structure or biochemistry, whereas the focus of investigative pathology is the elucidation of the underlying mechanisms related to tissue injury and disease processes. PATH is a 4-unit, graduate-level course providing students with the necessary foundation to incorporate investigative pathology into research programs relevant to human disease.

Basic principles of tissue injury and disease processes will be presented in the course lectures. Laboratory sessions will be used to illustrate material presented in the lectures. Prerequisites for PATH include basic courses in biology and biochemistry. Students are expected to work toward meeting the following objectives:. To become familiar with pathology nomenclature.

By the end of the course, the students are expected to be able to communicate an understanding of tissue injury and diseases processes using appropriate vocabulary. To recognize morphological and functional differences between normal and injured or diseased tissue. The first goal of the course is to learn to distinguish pathological lesions from normal tissue. The second goal is to understand, from a structural, functional, and biochemical perspective, the different types of pathological lesions and provide scenarios for how they each arise.

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To integrate pathological findings with clinical manifestations of disease. As this course is designed for graduate student training for research in the medical field, the students are expected to develop an understanding of the clinical features for certain disease processes. Particular emphasis will be placed on clinical aspects of cancer and heart disease. These features may impact on detection, treatment, or outcome of the disease or injury. To integrate the principles and information presented in this course with that from related disciplines.

Material presented in the course is expected to contribute to the body of knowledge that students will carry with them into a research career. In working toward a current understanding of the pathologic basis of disease, the student should develop a sense of which questions in pathology remain to be resolved. Basic Pathology, 9th ed. Kumar, A. Abbas, J. Aster eds. The textbook can be checked out, for 2 hours at a time, from the information desk at the AHSL library. The textbook is also available as an e-book.

The site provides contact information for faculty teaching the course, the course description, the course syllabus, a listing of course topics, and additional course resources including copies of lecture presentations and laboratory study guides. Course handouts, quizzes, and grades will also be available. General mechanisms of disease will be emphasized in the first part of the course.

Introduction

Knowledge about how these mechanisms manifest in specific organ systems will be the focus of the second part of the course. The laboratory will serve to illustrate and clarify material presented in the lectures and will focus on the consequences of disease processes in cells, tissues, and organs. The goal of the laboratory exercises will be to teach students a system for examining biological samples and making a pathologic diagnosis. Virtual microscopic whole slide images examinations—tissue sections. For every disease process presented in the laboratory, students will first be introduced to normal cellular and tissue structure.

With the normal structure as a frame of reference, students will then be asked to observe tissue sections representing a disease state and describe the changes they observe. Macroscopic examinations—gross specimens. Gross specimens of the disease processes under study will be presented along with the tissue sections. Students will be asked to describe the changes they see in the diseased tissue or organ. The exercises will help students relate the gross appearance of diseased tissues to changes in cellular structure.

From the integration of this information with the lecture material, students should be able to describe structural, functional, and biochemical changes that occur in cells, tissues, and organs, as the result of specific disease processes. Be able to distinguish between carcinomas and sarcomas and their tissues of origin and describe their benign equivalents. How do benign tumors cause problems? List the 3 most common cancers in men and women in the United States as well as the 3 most lethal cancers. Given a tumor name, be able to determine the cell of origin and describe its behavior.

Given the cell of origin, name the tumor.


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One out of every 5 persons in the United States who die this year will die of tumors approximately cases. Cancer L. Tumor L.

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In current usage, it is a synonym for neoplasm. Neoplasm G.

Associated Data

Oncology—the study of tumors. In current usage, an oncologist is an internist or surgeon who is specialized in treating neoplasms. Unfortunately, there are no rules to follow, these simply have to be learned. A hamartoma is not a tumor but a developmental abnormality that contains the same tissues as the organ in which it is found, but in the wrong proportions. A choristoma is a mass of normal tissue in an abnormal location.

Aspergilloma and tuberculoma are masses caused by infections. Granulomas are masses due to a chronic inflammatory process and hematoma is a collection of blood in an organ or tissue resulting from a ruptured blood vessel. Eponyms—tumors named after people who discovered, defined, or described them. Mixed—more than 1 neoplastic cell derived from 1 germ layer. For example, mixed tumor of salivary gland origin, Wilms tumor. Compound—more than 1 neoplastic cell type derived from more than 1 germ layer. For example, teratoma, teratocarcinoma.

Cells resemble normal cells and tumor architecture resembles that of the parent organ ie, it is well differentiated. Usually spherical and compress the surrounding tissues giving rise to the appearance of a capsule.

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Cells differ morphologically and functionally from normal cells and tumor architecture is less organized than that of parental tissue. Tumor cells are locally invasive—the tumor grows into the surrounding tissue and destroys it. Many tumors will eventually metastasize and spread to other sites within the body remote from the original site of the tumor. Altered nuclear features include increased amount of nuclear DNA, increased nuclear-to-cytoplasmic ratio, hyperchromatic nucleus, coarsening of chromatin, wrinkled nuclear edges, multinucleation, and macronucleoli.

Tumor cells will almost always biochemically and morphologically mimic one cell type of a normal organ, usually the one in which they arose ie, cells may continue to elaborate keratin, mucus, hormones, immune globulin, etc. The degree of differentiation is a reflection of the extent to which the neoplastic cell resembles its cell of origin both morphologically and functionally. The resemblance will be better or worse depending on the degree of differentiation that the tumor displays.

The well-differentiated tumors display many features morphological and biochemical of the tissue of origin whereas poorly differentiated tumors differ morphologically and biochemically from the tissue of origin. Squamous cell carcinomas may arise in any stratified squamous epithelium, either healthy skin, esophagus, mouth, and others or in the setting of squamous metaphasia bronchi, endocervix.

Note that adenomas may exhibit most of the same features though not glands-within-glands or signet-ring cells. Benign tumors generally are progressive and slow growing; they contain few mitotic figures.

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Malignant tumors exhibit erratic growth which may be slow or rapid and display numerous and often bizarre mitotic figures. Intraepithelial spread is possible and may take the form of single cells or of carcinoma in situ, in which an epithelial surface is replaced by a layer of several cells deep of malignant tumor that has not yet penetrated the basement membrane.

Death rate for gastric cancer is 8 times higher in Japan than in the United States; Japanese born in the United States—incidence is much lower. Worldwide, cancer of the cervix is the great killer of women. The other great third-world killer is hepatocellular carcinoma, which is primarily a disease in males associated with hepatitis B infection. Largest risk factor for cancers: older people—higher incidences of the most common cancers. Inherited cancer syndromes—autosomal dominant eg, familial adenomatous polyposis coli [APC gene defect] ; heredity nonpolyposis colorectal cancer HNPCC ; retinoblastoma.

Familial cancers family cluster, mechanisms, eg. Defective DNA repair—autosomal recessive eg, xeroderma pigmentosum; ataxia-telangiectasia. Moreno, PI. National Center for Biotechnology Information , U. Journal List Acad Pathol v. Acad Pathol. Published online Dec Margaret M. Briehl , PhD, 1 Mark A. Nelson , PhD, 1 Elizabeth A. Krupinski , PhD, 2 Kristine A. Erps , 1 Michael J.

Holcomb , 1 John B. Weinstein , PhD, 3 and Ronald S. Weinstein , MD 1, 4, 5. Mark A. Elizabeth A. Kristine A. Michael J. John B. Ronald S. Author information Article notes Copyright and License information Disclaimer. Corresponding author.

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Email: ude. This article has been cited by other articles in PMC. Abstract Faculty members from the Department of Pathology at The University of Arizona College of Medicine-Tucson have offered a 4-credit course on enhanced general pathology for graduate students since Keywords: Flexner 1. Other significant differences were the inclusion of 10 systems pathology lectures and 12 two-hour pathology laboratories in the graduate student version of the course Appendix A , Appendix B , and Appendix C In this article, we provide longitudinal data on this single-semester graduate student course PATH based on course enrollment and student performance data sets collected over 19 consecutive years.

Materials and Methods Background Mechanisms of Human Disease, designed for students pursuing a health science-related, non-MD, postbaccalaureate degree, was introduced at The University of Arizona in Institutional Review Board An evaluation was conducted by the Human Subjects Protection Program at the University of Arizona, which determined that the proposed course did not constitute human subjects research as defined by 45 CFR Student Recruitment Since PATH was offered initially as an elective course, students were recruited by disseminating information about the course through relevant graduate programs.

Curriculum The topics covered in PATH included cell injury, inflammation and repair, hemostasis and thrombosis, diseases of the immune system, neoplasia, genetic diseases, and infectious diseases. Laboratories A weekly, 2-hour laboratory session reinforced the lecture content by giving the students the opportunity to study gross and microscopic specimens of normal and relevant diseased organs and tissues. Open in a separate window. Figure 1. Faculty Two basic science faculty members, both PhDs, in the Department of Pathology currently serve as co-course directors and teach the first part of the course covering general pathological processes.

Data At the end of the semester, the students were given a survey to complete regarding their perceptions of the course. Statistics The data were analyzed with an analysis of variance ANOVA using grade as the dependent and year, degree, program, and gender as independent variables. Results Programs of Study for Mechanisms of Human Disease Students Table 1 lists the 21 programs of graduate school study plus nondegree seeking students for the students who enrolled in and completed PATH between and Table 1.

Figure 2. Figure 3. Student Evaluations of Mechanisms of Human Disease The percentage of students completing the evaluation survey per year is shown in Table 2. Table 2. Table 3. Acknowledgments The authors wish to thank Dr William Bellamy for his invaluable contributions in the first years of the course and Lynne Richter and Robert Hershoff for their expert technical assistance. Appendix A Table A1. Mechanisms of Human Disease Course Topics.


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