Vol 61 No 2 2021
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Pathodoodles
An Attempt at Simplifying Pathology
By Dr. Deeksha Sikri
Associate Professor, Department of Pathology, St Georges University School of Medicine, Grenada, West Indies
It was a rainy afternoon in Mangalore, India almost 15 years back. Our 2nd year Pathology practical examinations were close, and everyone was trying to make sense of the many (many) histopathological pictures- using gross markings on slides to make microscopic diagnosis! With my fascination and eagerness for the subject carrying me from the very first day of 2nd year, I was attending a revision class, for identification of cases for the upcoming exam. I clearly remember seeing a histopathological picture of a tuberculoid granuloma in a lymph node, then a few slides later in intestine and then in lung. I was captivated at the uniformity of the finding, the simplicity of just knowing the pathological cells and then putting them in different organs and making a diagnosis. The obvious nature of this makes me laugh now, but to the neophyte mind of a 2nd year medical student, it seemed like a revelation! “It is the similarity, not the difference!” my mind said, and I was hooked
Inspired by the wonderful teachers I had along the way, I have carried my approach of seeing patterns, identifying the similarities (and not just the differences), comparing, and contrasting into my teaching. Inspired by my students and more importantly, their doubts, and my earnest wish as a teacher for them to see what and how I could see and understand in Pathology, I started doodling. Simple, not very artistic, more schematic than representative but still legible enough to convey the shape of an epithelioid cell, the color of an oncocyte and the size of a diffuse large B cell lymphoma cell.
Our students just like us in the beginning of our respective journeys in this field, get lost in the pink, blue and purple hues of histopathology with the most common lament being, “Everything looks the same!”. In addition to the application, morphological understanding and its reasoning can help make students appreciate and identify the histopathological findings, perhaps even generate enough interest in the field to create more Pathologists! What makes the cells and tissues appear the way they do will even serve the larger purpose of helping them learn to question “why” and “how” – which are essential tools in Pathology and then clinical sciences, ultimately producing astute physicians.
Telling our students about the exquisite morphology of plasma cell, linitis plastica and renal cell carcinoma is essential. However, with the help of doodles, we can help them appreciate and therefore, remember so much more- in a way that will not be factual but sequential, which can be derived and recalled, and can be applied to other areas as well. Imagine if they could understand why the plasma cell has a basophilic cytoplasm and an eccentric nucleus, or how a mutation in CDH1 at a molecular level can lead to a diffuse leather bottle appearance of stomach at a gross level, or just why clear cell renal cell carcinoma is called so, and how that leads to its characteristic yellow color on gross. The potential for concept building in this manner is limitless! (Image 1)
I have found that doodles are also an effective tool for summarization. The sheer extent of material in Pathology is overwhelming, even to us as educators, but to the clean slate of a medical student, it can be even more overpowering. Sometimes, it is easy to get lost in the details and lose the simple track of just where you were in your reading! Putting together different examples or types of an entity under the same umbrella can be a useful reference point and resource for further reading.
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Another way we can use doodles is to help our students compare and contrast normal with abnormal, and even different types of abnormal. Seeing histology and histopathology side by side is one of the best ways to understand what has gone wrong and what does it look like. And within pathological entities also, different facets of an entity can be shown for comparison. Inflammation for example is ubiquitous and one of the first things they learn about when they are introduced to the subject. But even in its uniformity, it can have different facets in different organs and showing this can aid understanding and revision.
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As a resident, I would be frequently and then persistently overwhelmed with the many entities I would see on a daily basis. Residency is such a continuous learning process, it becomes difficult sometimes to collect yourself and what you’ve learnt. To that end, doodles can help put together different things under the same topic to define an approach and a pattern recognition.
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Free hand drawing (and not just of histological slides that are on the curriculum) is a basic yet underutilized tool. It is not a novel concept, but in the digital age with the advent of social media as a learning platform, I thought of reaching out across the borders and created “Pathodoodles” on social media around 1.5 years back. Right from explaining and pointing out identifying features for undergraduates to creating algorithms for approach to different lesions for residents, doodling has opened up a novel and unique way to introduce and explain Pathology to its learners. It is a form of teaching many teachers (including myself) employ, and a form of learning many students (including myself) utilize. I even encourage students to draw with me, so they know first-hand what a spindle cell of GIST, nuclei of papillary carcinoma thyroid and Auer rods of myeloblasts look like! I believe it is the best way to bring to life the words of Benjamin Franklin, “Tell me and I forget. Teach me and I remember. Involve me and I learn.”
(Pathodooodles, created by Dr. Deeksha Sikri is available on Facebook, Instagram, YouTube and Twitter)