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A METHOD OF TEACHING POSTGRADUATE PATHOLOGY AND THE IMPORTANCE OF CORRELATING RESEARCH KNOWLEDGE ARTHUR PURDY STOUT, M.D.* After a lifetime of more than fifty years of teaching the subject of surgical histopathology to young residents in their formative years, the following method of instruction has evolved. We have found this technique ofteaching surgical histopathology, and at the same time incorporating the value ofresearch information in helping to solve the problems ofclinical and surgical pathology, highly successful. The scene of action is the Francis Delafield Hospital, a small cancer hospital, which forms part ofthe vast complex ofthe Columbia-Presbyterian Medical Center, and is one ofa unit ofpathology laboratories forming the basis of instructional activity for teaching pathology to medical students and interns. I was formerly in charge of the laboratory at the Francis Delafield Hospital, as well as the larger laboratory of surgical pathology at the Presbyterian Hospital. Now I am a volunteer consultant to the laboratories at the Francis Delafield Hospital and to the surgical pathology laboratory at the Columbia-Presbyterian Medical Center. The residents in pathology at the Francis Delafield Hospital are part of the large group ofresidents who are rotated through the many subsidiary laboratories ofthe entire teaching complex at the Columbia-Presbyterian Medical Center. As consultant, I am at the Francis Delafield Hospital laboratories four days a week, and act as a moderator for the group ofresidents and the junior pathologists at our sessions. These are conducted around a large table where each one has his microscope, and has an opportunity to see sections of every case. Dr. Jacob Fürth is present and participates in the discussions, giving us the benefit ofhis vast experience * Consultant Pathologist, Francis Delafield and Presbyterian Hospitals, New York. 433 in the research fields ofneoplasms in animals and their application to the problems ofneoplasms in humans, and the possibilities for their treatment. My experience in this experimental field has been limited to a collaboration with Dr. Margaret Murray, in determining the cellular origin ofmany tumors formerly misinterpreted by older histological methods so that they were misunderstood. Thejunior members ofthe laboratory teaching staff at the Francis Delafield Hospital are all qualified investigators intheir own right, as well as having vast experience in interpretation on quick-frozen sections. Our method ofprocedure is to have one resident nominated each day to collect cases for presentation to the group. He has had prepared two comparable sections made from each paraffin block or frozen section so that sections can be passed down each side ofthe table enabling the residents, visitors, or other persons present, to have a chance to examine the slide. When all have had an opportunity to examine the slide, the moderator asks the resident who has presented the case to tell his diagnosis and explain his reasons for making it. The moderator then agrees or disagrees with the interpretation, or explains why he thinks the evidence is insufficient to warrant the suggested diagnosis, and calls for more evidence to be obtained either by cutting deeper into the paraffin block or examining other sections that have been made. Each member of the group expresses his opinion and then Dr. Fürth volunteers any light he can throw on the case from his experience with experimental investigations in tumors. Because ofhis vast experience with experimental tumors, Dr. Fürth is particularly well qualified to determine whether a lesion is a genuine neoplasm. He gives us the benefit ofhis knowledge gained from experimental tumors and the application to the case in question; especially as to whether it is primary or metastatic and either benign or malignant. For example, many tumors that are presented to us for diagnosis are composed largely of fibrous tissue, and the question frequently arises whether or not they are malignant. The cell that seems to react most frequently as a fibroblast many times is the histiocyte, which is primarily a phagocytic cell. It has not always been realized that the histiocyte can combine the two functions, producing cells that can form connective tissue fibers while, at the same time, some ofthe same cells can remain phagocytes . Dr. Fürth is reluctant to believe this interpretation, although it has been 434 Arthur Purdy...


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