Pathology discovered in the "first patient" can be the silent teacher of self-directed learning

Pathology found during cadaveric dissection has been used to model integrative teaching methods for medical students at several institutions. Recent evidence has shown that pathology found during dissection can be used in the design of self-directed learning (SDL) activities with standards that are difficult to meet. This study presents a novel method for providing formative feedback, one of the most challenging aspects for LCME accreditation of SDL activities. Three practitioners (two board certified pathologists and one board certified family physician) reviewed and rated pathological findings during routine dissection by first year medical students in the gross anatomy laboratory in New Orleans, Louisiana. The students also rated the findings, and a comparative score was given that provided quick, individualized formative feedback with no additional faculty time burden. The inter-rater reliability (IRR) among the clinical expert panel (n = 3) was adequate (IRR = 0.85). The students' percentage agreement with the expert panel was just under 57%. There was no significant correlation between the score on the Gift formative feedback instrument (FFI) and the students' performances in their gross anatomy course (p > 0.05). This study describes a FFI that allows for the variety of clinical presentations in cadavers dissected in the gross anatomy laboratory, while protecting faculty time that would otherwise be used for scoring individuals in large cohorts of medical students. This instrument can be used to integrate pathology and gross anatomy and provide a practical way of implementing self-directed learning.