Section 4 -

Impact of the Undergraduate Experience on Recruitment and Training in Pathology James Underwood Academic Unit of Pathology, Medical School University of Sheffield, UK

Many factors influence the career choices of medical graduates. These include: pegagogic aspects of undergraduate curricula awareness of career opportunities exposure to role models in different specialties prospects for employment and earning potential public reputation and professional standing of different specialties anticipated job satisfaction work schedules and family commitments. The amount of pathology in the undergraduate curriculum (e.g. number of teaching sessions) and the pedagogic mode of teaching and learning — didactic or problem-oriented — are believed to be major factors determining recruitment into the specialty. Many attribute declining recruitment to current trends in undergraduate curricula. The move from traditional didactic pathology-rich courses to modern problem-based learning curricula appears to coincide with increasing recruitment difficulties. The pathology content of the undergraduate curriculum also influences the ease with which new recruits progress through specialty training programs, particularly in the early years. Those who have done practical microscopy and witnessed autopsies as undergraduates are likely to develop postgraduate competencies in pathology sooner than those whose curricula were devoid of exposure to these learning opportunities. Furthermore, previous generations of pathologists were reasonably confident that they had the aptitude for their chosen specialty because they had experienced it as undergraduates. Graduates from pathology-depleted curricula will have had fewer opportunities to determine whether their aptitudes include, for example, pattern analysis and recognition. Concurrent with the trend towards problem-based learning, the emphasis in many medical undergraduate curricula is shifting significantly towards communication skills and clinical competencies, with less emphasis on science and pathology. Graduates from such programs are cast to become practising "doctors" (surgeons, physicians, etc) and may not regard pathology as sufficiently "clinical" to warrant their attention as a career opportunity. Given these trends in undergraduate medical education, active measures are needed to ensure buoyant recruitment of young doctors with the required commitment to and aptitude for pathology. The specialty needs to emphasise further its genuine "clinical" role so that it appeals to the graduates from the new style of curricula. The first year of our specialty training programs may need to adapt to the reduced exposure to pathology in undergraduate curricula. Bibliography Benbow E, Rutishauser S, Stoddart RW, et al. Pathologists and problem-based learning. J Pathol 1996;180:340–2 Domizio P, Wilkinson M. Pathology teaching in the twenty-first century. Clinical Teacher 2006;3:53–59 Fenderson BA, Hojat M, Damjanov I, Rubin E. Characteristics of medical students completing an honors program in pathology. Hum Pathol 1999;30:1296–301 Ford JC. Influence of a problem-based learning curriculum on the selection of pathology as a career: evidence from the Canadian match of 1993–2004. Hum Pathol 2005;36:600-604 Kumar K, Indurkhya A, Nguyen H. Curricular trends in instruction of pathology: a nationwide longitudinal study from 1993 to present. Hum Pathol 2001;32:1147-53 Lambert TW, Goldacre MJ, Turner G, et al. Career choices for pathology: national surveys of graduates of 1974–2002 from UK medical schools. J Pathol 2006;208:446–452 Marshall R, Cartwright N, Mattick K. Teaching and learning pathology: a critical review of the English literature. Med Educ 2004;38;302-313 Mattick K, Marshall R, Bligh J. Tissue pathology in undergraduate medical education: atrophy or evolution? J Pathol 2004;203:871–6 Nash JRG, West KP, Foster CS. The teaching of anatomic pathology in England and Wales: a transatlantic view. Hum Pathol 2001;32:1154-6