50 Years Ago in The Journal of Pediatrics:
Clinical-pathologic studies as a method of research
Article Outline
Arey JB. J Pediatr 1958;52:256-57
In this editorial, Arey emphasizes the importance of knowledge that can be gained by carefully performed postmortem examinations. Arey notes that from postmortem studies “a better understanding of the factors responsible for certain pathologic lesions may be forthcoming.” Arey also notes that rapid advances in medical science at the time tended to diminish the importance of classic approaches to the study of human disease, including the performance of autopsies.
The same situation is evident today, as we witness an explosion of knowledge in biomedical research. In spite of these tremendous advances, the postmortem examination remains a gold standard for use in the discovery and characterization of new human diseases. In addition, it serves as both an important educational tool and plays a critical role in quality control. Clinical-pathological correlates rely on practitioners providing the pediatric pathologist with an appropriate history and differential diagnosis so that histological findings are placed in an appropriate clinical context. Multidisciplinary rounds serve to facilitate such interchanges, and their merit should not be underestimated.
Over the years, there has been controversy regarding the merits of publishing clinical-pathological conference. Nay-sayers highlight the artificial nature of the presentation, the complexity of the cases chosen for presentation, and the potential for reinforcing the inappropriate over-testing of patients. Others acknowledge the importance of this approach as a teaching tool and as an aid in diagnostic reasoning.1 For this reason, The Journal of Pediatrics continues to publish case reports in the setting of a Grand Rounds presentation.2 Four of the last 20 case records presented in the New England Journal of Medicine (case 4-2007 to case 23-2007) were related to children and adolescents.
A web-based clinical-pathological conference as a teaching aid for use in the setting of undergraduate medical education has also been advocated.3 For students early on in their medical school training, the case-based conference brings immediate clinical relevance to their daily studies. Clinical-pathological conferences also serve as a method of introducing scientific reasoning and integration of acquired knowledge not only for medical students, but for graduate students who are training in the Life Sciences.4
Arey states in his editorial published 50 years ago that “The importance of careful observations, meticulous recording of facts, and correlation of the findings so recorded are often overlooked as an essential tool to medical progress.” Wise words that hold true to this day.
References
- . The art of diagnosis: Solving the clinicopathological exercise. N Engl J Med. 1982;306:1263–1268
- . A newborn infant with protracted diarrhea and metabolic acidosis. J Pediatr. 2007;150:198–201
- . Resuscitating the teaching of anatomical pathology in undergraduate medical education: Web-based innovative clinicopathological cases. Pathology. 2005;37:360–363
- . Complex medical case histories as portals to medical practice and integrative, scientific thought. Am J Physiol. 1992;263:S45–S54
PII: S0022-3476(07)00795-0
doi:10.1016/j.jpeds.2007.08.029
© 2008 Mosby, Inc. All rights reserved.
