Teaching medical pathology in the twenty-first century: virtual microscopy applications

Virtual microscopy (VM) has been implemented and evaluated in the histology and general and systemic pathology courses at the University of Iowa Carver College of Medicine. Advantages of VM over traditional microscopy include accessibility and efficiency of learning and the ability to integrate VM with computer-assisted interactive learning. Advantages of using VM as opposed to digital photomicrographs include the ability to pan and zoom, explore the slide, and make independent observations. Although VM is used in a case-based format for teaching histopathology to medical students at the University of Iowa, VM may also be effectively implemented in other medical-student teaching models, including integrated and problem-based learning curricula and the classical pathology laboratory. Additional Iowa venues and courses using VM teaching include pathology of human disease for bioscience graduate students, cytology education, a comparative pathology research resource, and histology and histopathology for veterinary medicine. This article reviews the history and evolution of VM in medical pathology and its implementation at Iowa.     

Introduction to the Swiss way of teaching veterinary pathology in the twenty-first century: application of e-learning modules

The teaching of pathology within the veterinary medical curriculum extends through the entire training period and has a dual role. General pathology deals with principles of disease processes as a basis for understanding the reactions of a multi-cellular organism to adverse effects; organ pathology builds on the principles of general pathology and explains the malfunctions of individual organs. Pathology is heavily image dependent and best taught in a highly interactive manner. The Institute of Veterinary Pathology, University of Zurich (IVPZ), has been actively developing concepts for teaching pathology in the new veterinary curriculum, which demands more active participation from students, with 20% of their study time devoted to individual study using traditional materials (books, articles, etc.) and e-learning modules. The Swiss Virtual Animal Pathologist is designed to cover and support the central elements of the Veterinary Pathology curriculum of the Vetsuisse Faculty. The needs of students and staff of the participating institutions for an interactive learning platform to supplement the existing face-to-face lectures and tutorials are the highest priority of this initiative.     

Tackling the knowledge explosion without overloading the student

SUMMARY Assessment of today's approach to veterinary education reveals a system overloaded with facts and students stressed to memorise and recall medical information. The Mississippi State University College of Veterinary Medicine has chartered a path to reduce the curricular information overload. The innovative incorporation of computers into the curriculum coupled with problem-based learning activities are preparing students to find information and learn on their own.     

Establishment of the European College of Veterinary Clinical Pathology (ECVCP) and the current status of veterinary clinical pathology in Europe

After 5 years of development, the European College of Veterinary Clinical Pathology (ECVCP) was formally recognized and approved on July 4, 2007 by the European Board of Veterinary Specialisation (EBVS), the European regulatory body that oversees specialization in veterinary medicine and which has approved 23 colleges. The objectives, committees, basis for membership, constitution, bylaws, information brochure and certifying examination of the ECVCP have remained unchanged during this time except as directed by EBVS. The ECVCP declared full functionality based on the following criteria: 1) a critical mass of 65 members: 15 original diplomates approved by the EBVS to establish the ECVCP, 37 de facto diplomates, 7 diplomates certified by examination, and 5 elected honorary members; 2) the development and certification of training programs, laboratories, and qualified supervisors for residents; currently there are 18 resident training programs in Europe; 3) administration of 3 annual board-certifying examinations thus far, with an overall pass rate of 70%; 4) European consensus criteria for assessing the continuing education of specialists every 5 years; 5) organization of 8 annual scientific congresses and a joint journal (with the American Society for Veterinary Clinical Pathology) for communication of scientific research and information; the College also maintains a website, a joint listserv, and a newsletter; 6) collaboration in training and continuing education with relevant colleges in medicine and pathology; 7) development and strict adherence to a constitution and bylaws compliant with the EBVS; and 8) demonstration of compelling rationale, supporting data, and the support of members and other colleges for independence as a specialty college. Formal EBVS recognition of ECVCP as the regulatory body for the science and practice of veterinary clinical pathology in Europe will facilitate growth and development of the discipline and compliance of academic, commercial diagnostic, and industry laboratories in veterinary clinical pathology. Future needs are in developing sponsorship for resident positions, increasing employment opportunities, increasing compliance with laboratory, training, and continuing education standards, and advancing relevant science and technology.     

The role of assessment in the student learning process

Assessment is a powerful learning tool that can enhance learning and education. The process of student assessment should align with curricular goals and educational objectives. Identifying the assessment strategies necessary for the proper evaluation of students' progress within individual programs is as important as establishing curricular content and delivery methods. The purpose of this paper is to discuss elements to be considered in assessment design and implementation as well as common challenges encountered during this process. Elements to be considered during assessment design include purpose of assessment, domains to be tested, and characteristics of the assessment tools to be employed. Assessment tools are evaluated according to four main characteristics: relevance, feasibility, validity, and reliability. Based on the evidence presented in the literature, the use of a variety of assessment tools is recommended to match diverse domains and learning styles. The assessment cycle concludes with the evaluation of the results and, based on these, the institution, program, or course can make changes to improve the quality of education. If assessment design aligns with educational outcomes and instructional methods, it improves the quality of education and supports student learning.     

Safety of a topically applied metaflumizone spot-on formulation for flea control in cats and kittens

Four laboratory studies were conducted in cats of various ages to evaluate the safety of a novel low-volume topical spot-on containing 20% metaflumizone (ProMeris for Cats, Fort Dodge Animal Health, Overland Park, KS) when used in cats according to the recommended minimum dosage of 40mg metaflumizonekg(-1) delivered via fixed volume doses of 0.8ml for cats 4.0kg. Study parameters included body weight, food consumption, clinical, physical and neurological examinations, and clinical pathology including complete hematology, coagulation, clinical chemistry and urinalysis. Exaggerated and repeated topical applications of metaflumizone at 1x, 3x and 5x the proposed recommended dose in adult cats and kittens 8 weeks of age had no effect on mortality, body weight, food consumption, clinical, physical or neurological examinations, or clinical pathology parameters. Transient salivation was sporadically noted following some, but not all treatment applications. It occurred and resolved within minutes of treatment application in all groups, including cats treated with placebo. Consequently, it was not considered a direct result of treatment with the active ingredient, metaflumizone. Cats orally administered 10% of the recommended topical dose exhibited considerable avoidance behaviors including spitting, head shaking, and salivation. Therefore, voluntary oral exposure is unlikely. No other adverse signs were observed. Repeated use of metaflumizone caused no adverse health effects when administered at 5x the recommended dose and is safe when used as directed, even on kittens as young as 8 weeks of age.     

ALTERNATIVES FOR IMPROVING VETERINARY MEDICAL STUDENTS'' LEARNING OF CLINICAL SONOGRAPHY

With the widespread clinical use of sonography there is a need to introduce the topic into the curriculum. A new problem-based course in clinical sonography without lectures was developed to emphasise experiential learning, and engage students actively in individual and collective acts of discovery. Four different approaches were used to deliver the new course to 141 veterinary medical students over four semesters. The physical principles of sonography were taught by computer-assisted instruction and a practical class, clinical examinations were introduced during a session with a tutor, and finally each student wrote an essay on a sonographic topic of their choice. To evaluate the new course, students' responses to a questionnaire were analyzed. Students gained reasonable understanding of the physical principles of sonography and had some confidence in conducting a sonographic examination of an animal. Of most use to student learning was discussion with the teachers. Surprisingly, half the students thought the topic should also be taught by lectures. The students learned the material and acquired the sonographic skills through processes which required more independence and self-responsibility than traditional teaching methods. The teachers' interaction with students on an individual basis, as they encountered individual problems, was the most important resource in learning about sonography. The continued request for lectures suggests an insecurity in some students caught between two different paradigms of teaching and learning (experiential, problem-based learning versus lectures).     

Competence at graduation: implications for assessment

Assessment of clinical competence is an integral component of veterinary medical and medical programs. Assessing competence is not straightforward, however, and there have been many studies in the medical education literature on the subject. This article seeks to review developments and current thinking in this important area.     

Evolution of a course in veterinary clinical pathology: the application of case-based writing assignments to focus on skill development and facilitation of learning

RATIONALE FOR STUDY: To encourage application and critical thinking, case-based writing assignments and grading rubrics were developed for use in a second-year core clinical pathology course. Objectives were to describe how this teaching technique was adapted to a large-class setting and how student perceptions of the learning experience guided modifications of this teaching technique over two presentations of the course and plans for a third presentation. Our goal was to enhance learning by encouraging application of course material to clinical situations and thereby improve students' ability to organize and communicate information. Furthermore, we evaluated the influence of instructor feedback on the learning process. METHODS: With assistance from the University of Minnesota Center for Writing, assignments and grading rubrics were developed. Students completed course evaluation surveys designed to elicit feedback on the impact of the assignments. RESULTS: Increased learner confidence was reflected in larger self-reported increases in understanding of the material and ability to apply information and in increased feelings of preparedness for class and examinations. A large majority of students advocated the use of such assignments in the course in future years, and modifications to make grading and evaluation of assignments more efficient are underway. CONCLUSIONS: Investment of faculty and student time in case-based writing assignments in the veterinary clinical pathology curriculum appears to increase student engagement with material and learner confidence. Future studies should address the impact of this type of assignment more specifically on clinical reasoning and communication skills and on long-term retention of material.     

Towards a humane veterinary education

There is a vast array of learning tools and approaches to veterinary education, many tried and true, many innovative and with potential. Such new methods have come about partly from an increasing demand from both students and teachers to avoid methods of teaching and training that harm animals. The aim is to create the best quality education, ideally supported by validation of the efficacy of particular educational tools and approaches, while ensuring that animals are not used harmfully and that respect for animal life is engendered within the student. In this paper, we review tools and approaches that can be used in the teaching of veterinary students, tools and approaches that ensure the dignity and humane treatment of animals that all teachers and students must observe as the very ethos of the veterinary profession that they serve. Veterinary education has not always met, and still often does not meet, this essential criterion.     

Integrated Case-Based Applied Pathology (ICAP): a diagnostic-approach model for the learning and teaching of veterinary pathology

Integrative Case-Based Applied Pathology (ICAP) cases form one component of learning and understanding the role of pathology in the veterinary diagnostic process at the Faculty of Veterinary Science, University of Sydney. It is a strategy that focuses on student-centered learning in a problem-solving context in the year 3 curriculum. Learning exercises use real case material and are primarily delivered online, providing flexibility for students with differing learning needs, who are supported by online, peer, and tutor support. The strategy relies heavily on the integration of pre-clinical and para-clinical information with the introduction of clinical material for the purposes of a logical three-level, problem-oriented approach to the diagnosis of disease. The focus is on logical diagnostic problem solving, primarily using gross pathology and histopathological material, with the inclusion of microbiological, parasitological, and clinical pathological data. The ICAP approach is linked to and congruent with the problem-oriented approach adopted in veterinary medicine and the case-based format used by one of the authors (PJC) for the teaching and learning of veterinary clinical pathology in year 4. Additionally, final-year students have the opportunity, during a diagnostic pathology rotation, to assist in the development and refinement of further ICAPs, which reinforces the importance of pathology in the veterinary diagnostic process. Evidence of the impact of the ICAP approach, based primarily on student surveys and staff peer feedback collected over five years, shows that discipline-specific learning, vertical and horizontal integration, alignment of learning outcomes and assessment, and both veterinary and generic graduate attributes were enhanced. Areas for improvement were identified in the approach, most specifically related to assistance in the development of generic teamwork skills.     

发达国家兽医协会的构成与职能

兽医协会早已有之,界定各国兽医协会历史比较困难。兽医协会一般均从兽医学会分立或隶属于兽医学会。兽医协会以会员利益为主体,服务于兽医行业,保护动物福利和健康。协会多由委员会及下属理事会构成。理事会是协会运作的主体,分设各职能分会、部门或机构。协会会员多需要经过正式的学术教育,且通过国家或地方兽医资格考试,有些国家还要求会员是注册兽医。兽医资格考试分为理论考试和临床技能考试。多数国家只需要通过理论考试,有些国家还需要通过临床技能考试。欧美国家还设有专科考试。     

Building on existing models from human medical education to develop a communication curriculum in veterinary medicine

Communication is a core clinical skill of veterinary medicine and one that needs to be taught and learned to the same degree as other clinical skills. To provide this education and essential expertise, veterinary schools in many countries, especially including North America, the United Kingdom, and Australia, have begun to develop programs and communication curricula. Human medical education, however, has 30 years' experience in developing communication curricula, and is thus an excellent resource upon which veterinary educators can build and shape their own communication programs. This article describes a skills-based communication course that has been successfully implemented for veterinary medical education at Ontario Veterinary College (OVC) and was based on the University of Calgary Faculty of Medicine's well-established program. The Calgary-Cambridge Guides and supporting textbooks provide the scaffolding for teaching, learning, and evaluation in both programs. Resources such as space and materials to support the OVC program were also patterned after Calgary's program. Communication skills, and the methods for teaching and learning them, are equally applicable for the needs of both human medicine and veterinary medicine. The research evidence from human medicine is also very applicable for veterinary medicine and provides it the leverage it needs to move forward. With this extensive base available, veterinary medicine is in a position to move communication skills training forward rapidly.     

Implementing a simulated client program: bridging the gap between theory and practice

INTRODUCTION: This paper outlines the design and implementation of an innovative communication skills training program at the Ontario Veterinary College (OVC). Based upon the body of research in human medical education reporting effective results through the use of standardized patients (SPs) for this type of training, an experiential learning laboratory using simulated clients (SCs) and patients was introduced to first-year veterinary students. METHOD: One hundred and four first-year students were assigned to 12 groups of eight or nine students plus a facilitator. Each student interacted with a simulated client and a patient while being observed by peers and a facilitator. The Calgary-Cambridge Observation Guide (CCOG) was used to guide students and facilitators with performance standards and feedback. Assessment strategies were utilized. RESULTS: Implementation of this program required extensive resources, including funding, expertise, facilitator training, time allotment in an already overburdened curriculum, and administrative and faculty support. Preliminary assessment revealed high student and facilitator satisfaction. The potential of this program for student education and assessment was recognized, and it will be expanded in years 2 and 3 of the DVM (Doctor of Veterinary Medicine) curriculum. CONCLUSIONS: Medical educators have created resources, including skills checklists and experiential learning modalities, that are highly applicable to veterinary medical education. Ongoing evaluation of the program is essential to determine whether we are meeting expectations for communication competency in veterinary medicine.     

New technology imperatives in medical education

A great deal of effort has been expended on trying to determine whether traditional instruction, online learning, or some combination of the two is of greater educational effectiveness.1, 2 This may be the wrong question. Rather than determining whether one delivery mechanism is superior to another, it is more important to choose the best method(s) of delivery to achieve specific educational objectives, taking into consideration the different learning styles and circumstances of the target audience. Although appropriate use of technology offers potential for improved learning, there are other compelling reasons to use technology in medical education, such as reaching a different audience or accessing unique expertise that would otherwise be unavailable. This article explores the ramifications of three important drivers of technology adoption for medical education: (1) public access to medical knowledge on the Internet; (2) change in what constitutes medical knowledge; and (3) the impending shortage of educators. Some approaches are proposed, including veterinary examples, to the challenges presented by these changes.     

Systematic review of comparative studies examining alternatives to the harmful use of animals in biomedical education

OBJECTIVE: To systematically review the published literature for controlled studies comparing learning outcomes of traditional methods that require the terminal use of animals (eg, dissection, live-animal surgery, and live-animal laboratory demonstrations) with outcomes obtained with alternative teaching methods. DESIGN: Systematic review. STUDY POPULATION: Controlled studies published between 1996 and 2004. PROCEDURES: PubMed was searched with the following keywords, used alone and in combination: educational alternatives, nonlethal teaching methods, veterinary alternatives, medical education, and nonterminal animal use. Cited references of retrieved reports were reviewed to identify additional reports. Reports were selected for review only if a comparison group was included. RESULTS: 17 studies that were randomized controlled trials or nonrandomized trials that included a comparison group were identified. Five involved veterinary students, 3 involved medical students, 6 involved university undergraduate students, and 3 involved high school biology students. Sample size ranged from 14 to 283 students. Eleven studies appeared to be randomized, parallel-group trials, 4 involved comparative groups to which participants were not randomly assigned or for which the randomization process was not clear, 1 was a 2-period crossover study, and 1 involved a retrospective review of grades. In all 17 studies reviewed, results associated with the alternative method of instruction were not significantly different from or superior to results associated with the conventional method. CONCLUSIONS AND CLINICAL RELEVANCE: Although the number of controlled studies identified was small, the results seem to support more widespread adoption of alternative teaching methods in biomedical education.     

Residency training programs in veterinary clinical pathology: a comparison of experiences at two institutions

Two institutions with different residency training formats in clinical pathology are compared with respect to application procedures, learning and teaching opportunities, learning resources, research training, publication requirements, and assessment methods of the program and trainees. The University of Florida and Purdue University programs are both based on an emphasis in morphologic recognition and interpretation of disease processes as well as training in basic science and applied research principles. The progress of trainees through each program is carefully monitored to meet individual needs as well as to meet the training requirements to allow candidates to sit for the certifying examination in clinical pathology. Periodic mock board exams are a critical tool to assess trainee progress and learning. The differences in format focus on coursework and publication requirements as well as on program assessment tools. While one program provides training in the form of 75% clinical diagnostic service, the other uses a mixture of 50% coursework and 50% clinical diagnostic training. Despite the contrast between a pure residency training program and one combining residency training with an MS degree, both institutions provide a solid program structure, ample learning resources, and adequate faculty mentorship to produce a high pass rate of board-certified specialists, the major focus for both programs. Numbers of post-training employment positions for both institutions are similar for those selecting faculty positions at veterinary schools. During the period studied, however, the combined residency and MS graduate program at Purdue University produced more graduates employed in pharmaceutical and biotechnology companies, while the residency program at the University of Florida produced more graduates employed by diagnostic laboratories.     

From Osler to Olafson. The evolution of veterinary pathology in North America

Most branches of biological science in North America developed first in the United States, and later were taught and practiced in Canada. An exception was veterinary pathology, which as a discipline taught in veterinary colleges and as a field of research, developed first in Canada, and from there crossed the border to the United States. Pathology was first taught at the Montreal Veterinary College, founded in 1866 by Duncan McEachran, a graduate of the Edinburgh Veterinary College. From the outset, he formed a close association with the medical faculty of McGill University, permitting his students to attend the same classes in the basic subjects with the medical students. Eventually, the Montreal Veterinary College became formally affiliated with McGill University, as the Faculty of Comparative Medicine and Veterinary Science. The McGill veterinary faculty was forced to close for economic reasons in 1903, but it left an enduring legacy, particularly in the field of veterinary pathology. The legacy, a novel concept in the 1870's, was that pathology was the cornerstone of a veterinary education; the place where anatomy, physiology, chemistry and botany met with the clinical subjects, and gave the latter meaning. This tradition was formed at the Montreal Veterinary College by the world renowned physician William Osler, North America's leading medical teacher, whom McEachran had invited to teach at the College in 1876 in addition to his duties in the faculty of medicine. Osler had studied with Virchow in Berlin and applied his methods of autopsy technique and of scientific inquiry to his teaching of both human and veterinary pathology at McGill. Osler also undertook investigations into various diseases of domestic animals, at the request of McEachran, who doubled as Chief Veterinary Inspector for the Dominion Department of Agriculture. Osler left McGill University in 1884. Only after that year did other North American veterinary schools adopt pathology as a discipline of instruction. However, by 1884, Osler had already left his indelible imprint on the students (both medical and veterinary) he had taught in Montreal, one of whom took over the teaching of pathology in the veterinary college. Another, who followed Osler's example and also studied in Berlin with Virchow, wrote the first book in the English language on veterinary post mortem technique in 1889.(ABSTRACT TRUNCATED AT 400 WORDS)     

Successful medical treatment for globe penetration following tooth extraction in a dog

A five‐year‐old entire male Tibetan Terrier was referred for left‐sided periorbital swelling and blepharospasm 4 days following ipsilateral maxillary tooth extraction. Examination of the left eye revealed mild exophthalmos, pain on retropulsion, and absent menace response and pupillary light reflexes. Examination of the posterior segment was not possible owing to the anterior segment pathology. Differential diagnoses considered were iatrogenic globe penetration and peribulbar abscess/cellulitis. Ocular ultrasound was consistent with a penetrating wound to the globe. Treatment with systemic prednisolone and marbofloxacin, and topical atropine sulfate 1%, prednisolone acetate, and brinzolamide was started. Marked clinical improvement allowed visual confirmation of the perforation. Oral prednisolone was tapered over the following 10 weeks. At final re‐examination (10 months), the patient was visual, and fundic examination revealed an additional chorioretinal scar, most likely an exit wound that was obscured by vitreal debris on initial examinations. Neither scar was associated with retinal detachment. To the authors' knowledge, this is the first reported case of successful medical management of iatrogenic globe penetration following exodontic procedures.