The Effective Pathology Tutor

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You have been chosen to provide supplemental instruction in pathology at the medical school level.

You are responsible for students who are having academic difficulty for the first time in their lives.

The problem is never lack of innate ability.

The problem is almost never lack of motivation.

If the student is really having more difficulty with pathology than with other subjects, the problem is not ill-health or a personal life situation.

Almost always, your students have sought supplemental instruction because they have not learned how to approach the subject itself.


The WORST thing you can do is prepare or deliver mini-lectures.

Is that clear?

What you MUST do instead is to get THEM to talk and use the principles of pathology to approach specific situations -- identifying lesions, and making blocks of material their own.

You use the same skills as a pathology tutor that you must use as a practicing physician. Start with open-ended questions. They learn by applying principles to specific problems that you pose. Close by talking about how to handle problems in the future.

Looking at Pictures

Plan to spend at least half your time doing this.

Usually it's best to ask the students to select which sequence pictures they will view. For my course, you have the lecture kodachromes, the lecture-notes clickable links ("skulls and 'scopes"), and the Slice of Life videodisk.

Flash up a picture. Smile. Remember that the less you say, the better. You have a greater tolerance for silence than they do. If the students do not say anything, say, "Where are we?" If this gets no answer, tell where we are. For my course, "Ed always tells the organ."

Next, "What do you recognize?" If the group recognizes nothing, "What features of normal _____ are present?" In neoplasia, the answer may be, "None." If you get an answer, ask "How did you recognize that?" or "How will you recognize it next time?"

Now the coaxing for a diagnosis begins. Draw on your principles. For awkward silences, there are several standard questions. "Inflammatory or neoplastic?" "When you see mostly [white cell type], we usually think of what?" "Do you see anaplasia?" "What things look yellow on gross exam?" "On this stain, what stains this color?" "What features suggest that a tumor is malignant?"

Continue to narrow it down, inviting the students to use their notes. Eventually you should be able to get the diagnosis for most lesions out of most groups most of time. When you have accomplished this, you'll probably want to say, "How will you recognize a _____ next time? When you are done with an image, consider asking the group, "How would the lesion you just saw affect the person, in terms of symptoms an signs?"

This is far better than saying "This is _____ because _____." I already did that in lecture, and they didn't learn it then. This kind of teaching is also much more of a challenge than just bugging them for answers. I'm counting on you.

Mastering the Non-Picture Content ("Pathophysiology")

In medical education, "pathophysiology" is a specific term that refers to the pathology content that is NOT learned from photos, and where the focus is not on correlating structure and function. (A course in "pathophysiology" is a course on disease without images, taught by non-pathologists.)

Your task is to guide the students as they add pathophysiology to their personal database. Your approach may be more varied than with pictures, so long as you do not do most of the talking. The students do need to learn, early, that you're not going to do their work for them. (There are other dumb-it-down resources. They don't help as long as the lectures are good.)

For example, you may begin a section on lung cancer, "What about lung cancer?" This may get a response from the group. If you have a very good group, they will ask you a lot of questions that begin with "Why...?" Otherwise, you can begin, "What do you remember about...?" As you go through the content, ask repeatedly, "Do you understand why...?" Instead of saying, "Do you know....", ask "Who remembers....?"

When somebody remembers a specific term or concept, say, "How did you remember that?" or "How did you figure that out?"

At some time, you can ask, "How will you organize _____ in your minds?" A little chalk sketch, like I often make in class, can be helpful. If a group member can do this, so much the better. Otherwise, it's your task. Be creative but remember not to lecture.

The Successful Tutor

Peer teaching is fundamental to medical education. Your contribution is very important.

Any scribe can rehash a pathology lecture. It takes a real understanding to get the students to make the material their own.

Occasionally, you may encounter a student who has some personal or health problem. Attention deficit disorder is sometimes unmasked at the medical school level. If you suspect anemia, thyroid disease, sleep apnea, or one of the other common health problems that interferes with learning in young adults, share your thoughts.

If you learn of a personal problem, encourage the student to take appropriate action.

If one student dominates discussion, invite that person to remain silent "for a while." If a student is not participating, ask him/her easier and easier questions until you get an answer. This may jump-start that individual.

Tutoring pathology is more like the real practice of medicine than you'd think. It's largely about people, and reacting to their needs and questions moment by moment. You rely on your knowledge of the principles of medicine. Just as with a physician office visit, the people should leave feeling better than when they went in.

Welcome to our ranks as instructors in the science of disease.

Ed's old exams
Approaching the Unknown Glass Slide
Kansas City Field Guide to Pathology
Back to Ed's


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