REVIEW DIAGNOSTIC HISTOPATHOLOGY 14:9 453 © 2008 Elsevier Ltd. All rights reserved. Designing assessment of pathology in the undergraduate curriculum Ray F T McMahon Emyr W Benbow Abstract The teaching and learning of pathology in undergraduate curricula are changing and the methods of assessment of the pathology component need to change with them. The curricular changes from the older, tra- ditional programmes to newer, more integrated courses, often using a problem-based learning (PBL) approach, are a challenge for pathologists at a time of reduction of academic pathology posts. However, patho- logists have a broad range of knowledge and skills that are invalu- able in undergraduate teaching, learning and assessment. These should be encouraged in training grades and promoted by established patho- logists as ‘role models’. Newer forms of assessment provide an op- portunity for pathologists to maintain the profle of the discipline since ‘assessment drives learning’. These methods include the incorporation of well-designed clinical scenarios with pathological relevance into multiple choice questions (MCQs) and extended matching questions (EMQs), examples of which are given. Similarly, objective structured clinical examinations (OSCEs) also allow the use of clinically relevant settings such as death certifcation and multidisciplinary team meetings in undergraduate examinations. Pathologists should get involved in all levels of assessment, especially in question writing and quality assur- ance. They should also participate in OSCEs and function as external examiners to maintain the profle of pathology to undergraduates. Keywords assessments; EMQ; MCQ; medical education; OSCE; pathology Introduction The teaching and learning of pathology within the undergraduate curriculum has changed considerably over the last two decades, 1,2 as have the methods of examination and assessment. These cur- ricular changes have reduced pathology teaching in most medi- cal schools and this has been compounded by a decrease in the number of academic pathologists. Nonetheless, there is still a need to ensure that pathology is represented within medical Ray FT McMahon BSc MD FRCPath is a Senior Lecturer in Pathology at the Medical School of the University of Manchester and an Honorary Consultant Pathologist at the Department of Histopathology, Manchester Royal Infirmary, Manchester, UK. Emyr W Benbow BSc MB ChB FRCPath is a Senior Lecturer in Pathology at the Medical School of the University of Manchester and an Honorary Consultant Pathologist at the Department of Histopathology, Manchester Royal Infirmary, Manchester, UK. school curricula and that the assessment process reflects the con- tribution of pathology to the undergraduate programmes. What do we mean by pathology? Traditionally, pathology refers to tissue pathology (histopathol- ogy and cytopathology), often divided into ‘general’ and ‘sys- temic’ pathology. General pathology covers disease mechanisms, e.g. degeneration, inflammation and tumourigenesis, whereas systemic pathology defines the pathological processes and their consequences in each body system in turn. Many curricula also include other aspects of the laboratory disciplines, including immunopathology, haematology, microbiology (including infec- tion control) and clinical chemistry, integrated in a variety of ways with histopathology. Why teach pathology in the undergraduate curriculum? Many clinicians involved in direct patient care acknowledge the need to understand general pathology (including inflammation, wound healing and repair), vascular pathology (including ath- eroma, thrombosis, embolism, ischaemia, hypertension and car- diac failure) and neoplastic disease, but many students fail to appreciate how pathology governs diagnosis and management. As pathologists, much of our role in patient care is determined by how well (or otherwise) our clinical colleagues appreciate these principles, and unless we ensure that our students have a grasp of (what is to us) basic pathology, future generations of medical practitioners may lack this understanding. The vocabulary of pathology underpins communication with colleagues and is gaining ever greater prominence, e.g. without this common language, colleagues from other specialties will be unable to follow multidisciplinary team meetings. Pathologists have long been appreciated for their ability to straddle the inter- face between basic science and clinical practice in undergraduate education, maintaining the important link between basic biosci- ences and clinical practice. To the general public, and to a lesser extent to the non- pathological medical community, pathology relates only to autopsy practice. This is a gross over-simplification but the important role of autopsy in the audit of general medical practice must not be underplayed. There has been an enormous change in the perception of autopsy practice as a result of the Alder Hey and Bristol scandals, a perception only partly alleviated by the Human Tissue Act 2004. Pathologists need to ensure the highest possible standard of practice in the autopsy room, and to convey their high standards in interactions with undergraduates as well as with other members of the medical profession and the general public. Old curricula Traditionally, general pathology was taught in the preclinical phase. Typically, this included lectures on the principles of disease in the three broad areas of inflammation and repair, vascular pathology and neoplasia. This was often supplemented by demonstrations of gross pathology (including autopsies and the use of ‘wet’ specimens) and of histopathology, using H&E- stained sections of common pathological conditions.