Core morphological concepts of disease for second-year medical students

With the increasing emphasis on independent learning and early patient contact, the time in the undergraduate medical curriculum for formal teaching of morphology of disease is decreasing. Thus, we thought it advisable to identify those core morphological entities of disease that should not get lost in the new paradigm. Our approach was to list all disease processes in Robbins Pathologic Basis of Diseases, 5th edition, that have distinguishing gross or microscopic characteristics. Appropriate portions of this list of 952 morphological entities from the Robbins textbook were distributed to 46 clinical specialists and pathology faculty. Each of these was asked to strongly agree, agree, disagree, or strongly disagree with the following for each entry on the list: "For purposes of developing concepts of disease, an M2 physician in training should recognize classical examples or a diagrammatic representation of the following lesions, and distinguish them from each other." Responses resulted in a consensus core list of 63 general disease process lesions and 545 organ system lesions, for a total of 608. These 608 core morphological entities were incorporated into our course by means of (1) a computer program with over 1,022 images and clinical-pathological correlations, and (2) a core list of morphological objectives for each unit in the course. In general, entities were judged noncore material if they were rare or were microscopic lesions of primary interest to pathologists and provided no major pathomorphologic concepts. The computer program as a supplement to glass slides and gross specimens has been very well accepted by students, and satisfactory performance on examinations has been maintained in spite of a 25% reduction in pathology course contact hours.