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|NI FEATURE: TIMELESS REVERBERATIONS - COMMENTARY
|Year : 2017 | Volume
| Issue : 1 | Page : 2-4
Clinicopathological conference: A strong educational tool
Ashru K Banerjee
Formerly, Chairman, Department of Pathology and Professor of Neuropathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||12-Jan-2017|
Dr. Ashru K Banerjee
#146, Sector 7 Panchkula 134109, Haryana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Banerjee AK. Clinicopathological conference: A strong educational tool. Neurol India 2017;65:2-4
Clinicopathological conferences (CPC) are practiced all over the world. In India, only a handful of institutions have a CPC program using their own material. The following account is a personal experience of how the practice evolved at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh.
The saga of CPC at the PGIMER, Chandigarh is a success story validated by wide popularity and acceptance both at home and outside. The PGIMER CPC material has been utilized by other institutions, has been published by several journals, and more recently, its live proceedings are being transmitted through the electronic media. I have presented our CPC at other institutions, including a few outside India, as has also been done by my colleagues. Several visiting professors have shown a keen interest in discussing the cases here on Wednesdays. The exercise has been uniformly appreciated as an excellent teaching material that is immensely helpful in enhancing professional skills.
The relatively low profile Monday CPC has turned out to be an important component of the postgraduate training. This is particularly true for pathology trainees. It not only helps them in learning the subject but also helps in developing skills that are necessary for their growth as future teachers. The research in medical education has shown that problem-based learning is highly effective; therefore, the CPC not only has a rich tradition behind it but is also an efficient knowledge-imparting tool. (Incidentally, I had the privilege of presenting the pathology part in the first residents' CPC of the PGIMER).
Several eminent individuals have contributed to the success of the CPC and in establishing the tradition. But how did it begin?
To the medical profession, the CPCs of the Massachusetts General Hospital, published in the New England Journal of Medicine, were well known. Some institutions purchased slide sets of the cases for their own academic benefit. The Hammersmith Hospital, London was another source of inspiration. The visit by Prof S.S. Anand, Prof P.N. Chuttani, and Prof B.K. Aikat to the latter hospital certainly provided the required stimulus. The lunch time demonstration of the gross pathology of the day's autopsy, as was being practiced at the Hammersmith Hospital, was introduced at the PGIMER, but was discontinued after some time.
The essential element in the efficient conduction of CPC is the availability of facilities for autopsy material, and that too in good numbers, to run a regular weekly programme. In Indian hospitals, medical autopsy is not popular. Several reasons have been cited, and PGIMER has shown that most of these are not true. It is possible to get consent for autopsy with some efforts and adjustments. The main architects in the establishment and regular conduction of autopsy were Prof P.N. Chuttani and Prof B.K. Aikat. Prof Chuttani was absolutely convinced of the value of an autopsy. He even willed his own body for an autopsy, which was actually carried out. His determination paved the way for other colleagues to make sincere efforts for securing consent. The autopsy rate at PGIMER progressively increased. In fact, the load at times was more than what we could handle. The Monday CPC was introduced with two cases per week, which were relatively simple cases with a good clinicopathological correlation [Figure 1],[Figure 2],[Figure 3].
|Figure 1: 1966. Dr. Zakir Hussain, President of India, visiting the Pathology Department on the occasion of inauguration of the research block A. From left to right: Prof. S.S. Anand, Director, Prof. P.N. Chuttani, Dean, and Prof. B.K. Aikat, Director-Professor of Pathology, escorting the chief guest. Also present was Dr. Ashru K. Banerjee (in white coat on the extreme right)|
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|Figure 2: 1972. Mr. D.P. Dhar, Advisor to the Prime Minister of India, visiting the Pathology Department. From left to right: Prof. P.N. Chuttani, Prof. B.K. Aikat, Mr. D.P. Dhar, Dr. A.R. Khan, and Dr. Ashru K. Banerjee|
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|Figure 3: 1993. Farewell dinner in honour of Prof. B.N. Datta, Dean and Head of Department of Pathology, with Prof. P.N. Chuttani and Prof. Ashru K Banerjee|
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The quality of presentations has continuously improved over the years. Newer techniques, greater objectivity, and introduction of standardized methods of examination have contributed to the academic value of the sessions. The demands of the medical and surgical superspecialities have been addressed. However, more refinements are expected in the future.
Is the CPC relevant today? The question has been raised repeatedly, particularly in view of the development of newer diagnostic tools. My answer to the question is a definite and emphatic “yes.” Various publications, including our own, indicate that a significant discordance exists between the clinical and postmortem diagnosis. The figure for this discordance is even higher for the second major pathology, when present. It should also be noted that several deaths occur after only a short stay in the hospital and, therefore, are not adequately investigated. Such cases are discussed mainly based on their clinical features, and the wide list of differential diagnosis available for them makes them interesting.
The CPCs of PGIMER have contributed towards increasing awareness of several diseases, leading to a knowledge gain that leads to establishment of a correct diagnosis during the life of patients, as well as in subsequent years. Significant contribution has been made in conditions such as amoebic liver abscess, noncirrhotic portal fibrosis, rheumatic heart disease, normal valve endocarditis, cerebrovascular disease, paralytic rabies, tuberculous and fungal infections, a large spectrum of renal disease, and perinatal pathology.,,,
It is extremely satisfying to see the programme running successfully for over five decades, and it is expected that the tradition will be carried forward in the future as well.
This article is modified from a talk delivered by the author during the golden jubilee celebrations of the PGIMER, Chandigarh.
| » References|| |
Sarode VR, Datta BN, Banerjee AK, Banerjee CK, Joshi K, Bhusnurmath B, et al
. Autopsy findings and clinical diagnosis: A review of 1000 cases. Hum Pathol 1993;24:194-8.
Banerjee AK, Varma M, Vasista RK, Chopra JS. Cerebrovascular disease in north-west India: A study of necropsy material. J Neurol Neurosurg Psychiatry 1989;52:512-5.
Patel FM, Das A, Banerjee AK. Neuropathological complications of infective endocarditis: Study of autopsy material. Neurol India 2002;49:41-6.
Chatterjee D, Radotra BD, Vasishta RK, Sharma K. Vascular complications of tuberculous meningitis: An autopsy study. Neurol India 2015;63:926-32.
Chopra JS, Banerjee AK, Murthy JMK, Pal SR. Paralytic rabies: A clinicopathological study Brain 1980;103:789-802.
[Figure 1], [Figure 2], [Figure 3]