The Effectiveness of a First Patient Discoveries Project in Promoting Observational Medicine and Diagnostic Decision‐Making

Abstract

IntroductionCadaveric dissection presents a unique opportunity to integrate basic and clinical sciences, as students encounter disease processes in their first patients, their body donors. At the Medical College of Georgia, the First Patient Discoveries Activity was introduced for first year medical students during the 2016–2017 academic year. This yearlong integrative exercise introduces students to their first patient through careful observation and practice of clinical problem solving. The goal of the activity is to assess multiple competencies including observational medicine skills, evidence‐based reasoning, and awareness of how public health and psychosocial issues contribute to health and disease.Purpose and HypothesisThe purpose of this study was to assess the effectiveness of the First Patient Discoveries Activity for promoting observational medicine skills and integration of clinical and basic science among first year medical students. We hypothesized that students would integrate gross and microscopic observations with clinical science to draw appropriate conclusions about their body donor's cause of death (COD).MethodsFirst year medical students (n=190/year) were divided into 24 dissection groups. While dissecting, students complete a body donor observation form, noting gross anatomical findings. When students believe they have identified pathology, they biopsy it and submit a short report indicating their reason for the biopsy. After examining histological slides from their biopsy and forming initial hypotheses, students receive feedback from a pathologist. Based on their observations and pathological findings, students hypothesize the COD from a provided list (or deduce an alternate cause). The assignment is evaluated using a grading rubric. End of year reports were analyzed to assess students' abilities to identify their body donor's COD and explain their diagnostic reasoning.ResultsOf the 24 dissection groups, 5 identified their body donor's official COD, while an additional 5 groups presented evidence to support an alternate COD. Biopsies were key to successful diagnoses. The average number of biopsies per group was 3.08 (range 1–7), with groups who correctly hypothesized the official COD taking more biopsies than groups submitting incorrect hypotheses. Most groups exceeded expectations in their discussion of how observed pathologies contributed to their COD hypothesis (avg. score 92.6%) but struggled to demonstrate observational skills on the body donor observation form (avg. score 69.5%). Interestingly, students hypothesized cardiovascular pathologies, but no groups biopsied the heart. This omission led to 9 incorrect hypotheses and 5 missed diagnoses. Students drew logical conclusions from biopsies of lung, brain, and neoplastic tissue. However, overall diagnostic reasoning needed improvement to understand that multiple pathologies can affect a patient and that the patient's age and all of the organ systems should be assessed in order to make a diagnosis of exclusion.ConclusionIn its first year, the First Patient Discoveries Activity promoted integration of basic and clinical sciences content, observational medicine skills, and mindfulness of how pathologies affect patients' mortality. The project was modified for 2017–2018 to require biopsies of heart, lungs, and a large blood vessel, since these organs can give strong indication of overall health at the time of death.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.