Journal of Postgraduate Medicine
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EDITORIAL
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Year : 2021  |  Volume : 67  |  Issue : 2  |  Page : 61-62  

”Diagnostic pulmonary pathology web series”: Journey of a virtual educational initiative during COVID pandemic

S Nagoti1, P Vaideeswar2,  
1 Consultant Pathologist, BJ Wadia Hospital for Children, Mumbai, Maharashtra, India
2 Department of Pathology Cardiovascular and Thoracic Division, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India

Correspondence Address:
P Vaideeswar
Department of Pathology Cardiovascular and Thoracic Division, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra
India




How to cite this article:
Nagoti S, Vaideeswar P. ”Diagnostic pulmonary pathology web series”: Journey of a virtual educational initiative during COVID pandemic.J Postgrad Med 2021;67:61-62


How to cite this URL:
Nagoti S, Vaideeswar P. ”Diagnostic pulmonary pathology web series”: Journey of a virtual educational initiative during COVID pandemic. J Postgrad Med [serial online] 2021 [cited 2021 Aug 1 ];67:61-62
Available from: https://www.jpgmonline.com/text.asp?2021/67/2/61/315373


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Coronavirus disease 2019 (COVID-19) is defined as an illness caused by a novel coronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Following its initial isolation in December 2019 from the bronchoalveolar lavage (BAL) sample in a 41-year-old Chinese patient, there was a tremendous global upsurge in the number of cases. Finally on 11th March 2020, the WHO declared COVID-19 a global pandemic.[1] As a measure to contain the spread, lock down with sanitary guidelines and social distancing had been stringently followed in many countries, along with recommendations of work-from-home. The same measures had to be adopted in most of the medical centers, especially medical colleges where there was a sudden shift towards online ways of teaching as a new normal.

The pathogenesis of COVID 19 begins with interaction of the viral envelope spike protein with the host angiotensin-converting enzyme 2, which is abundantly expressed on the surface of alveolar cells, bronchial cells, and vascular endothelium in the lung.[2] This made the lungs as the most common site of infection with varied histopathological features such as diffuse alveolar damage, interstitial pneumonitis, and/or microvascular thrombosis.[3] In these circumstances, non-neoplastic pulmonary pathology was thrust to the fore-front. Unfortunately, there is a significant diagnostic delay and even misdiagnosis of non-neoplastic lung lesions, particularly in the context of diffuse lung diseases.[4] Such lesions are often biopsied and many times, the biopsy interpretation is considered an insurmountable challenge to a surgical pathologist.[5] The reasons for this predicament are manifold. Importantly, a diagnosis has to be offered on a limited sample size for a disease which may have a varied distribution and heterogenous appearance.[5] There is also a possibility of the simultaneous presence of more than one disease. Lamentably, there is a lack of immunohistochemical back-up and in most of the cases, the diagnosis is rendered on routine hematoxylin and eosin stained sections. Finally, of course, there is seldom sub-speciality pulmonary pathology training during residency.

Considering the above issues, it was deemed imperative to have proper training in non-neoplastic pulmonary pathology. To carry out this objective, the Pulmonary Pathology Teaching Club (PPTC) was formed as a voluntary independent platform without any external support either from any Institute or from any other organizing body. The club was formed by a core team of 4 pathologists with special interest in pulmonary pathology and they functioned as course coordinators and/or panelists. The logo of the club [Figure 1] was designed and adopted. The team had no prior experience in conducting such activities. Hence, there was a lot of brainstorming in designing the course, planning , organizing, and conducting the sessions and also in dealing with the technical issues. To deal with all these issues smoothly and efficiently, designations and roles were assigned to all the team members. Choosing and maintaining a technical platform was a big challenge. Different online platforms were explored in terms of their quality, features, security, and ease of use, and finally the Zoom service was finalized. To deal with connectivity or malfunction issues at the time of joining the session or during the session faced, the technical support team was instructed to be available to them on phone to sort the issues on real time basis. In order for the sessions to run smoothly and successfully, certain guidelines were laid down to be implemented and adhered to by all the team members, invited speakers as well as by the participants, particularly to avoid background noise disturbances and other distractions.[6],[7]{Figure 1}

Since the aim of the club was to train the post-graduates, junior faculty, and practicing pathologists in this less explored sub-speciality, an educational course “Diagnostic Pulmonary Pathology Web Series” was designed. The course was designed in 2 modules spread over 9 months with 8 sessions in each (2 sessions a month). Module 1 and Module 2 covered non-neoplastic and neoplastic pulmonary diseases, respectively. The brochure was designed with all the required details and was advertised through various social media platforms. The duration of the session was scheduled for 90 minutes. The course format included algorithmic or theme-based lectures, case-based discussions, and slide seminars (considered as a favorite among the post-graduates). It was decided that the topic of presentation should have up-to-date focused material, representative images (preferably from own experience), and supporting references. While presenting the cases, especially in slide seminars, certain precautions like providing approximate age instead of the exact age, avoiding display of full facial images, etc., were to be done to maintain patient privacy. For further assistance in this aspect, a prior rehearsal session was also held for feedback and suggestions from the team members, especially the practical experiences. The need for clinical, radiological, and pathological correlation was to be heavily emphasized in all sessions.

The 1st session was conducted on 1st October 2020. Every session had main speaker and other team members as the panelists. Prior to the start of the lecture, the speaker would log in to the virtual meeting in advance to run a quick test trial and resolve any unforeseen technical issues prior to the participants log in. Use of head or ear phones helped in achieving best sound quality as they cancel out all other external noises. Before the start of each lecture, a pre-assessment poll was taken wherein the participants were instructed to submit answers to questions posted in real-time by the faculty who would be lecturing on the scheduled topic. This helped in analyzing the students' knowledge, giving an idea to the instructor about which points of the topic are to be dealt with in more detail. At the end of the session, the questions posted by the attendees were usually answered by the speaker and the other panelists and was followed by post-education assessment. Digitized slides were used in some of the lectures, which helped the participants to see the biopsy slide virtually under all magnifications. The average number of participants attending each lecture was approximately 100. Replay sessions after the live session were organized for participants who missed the live session, very often due to COVID emergency duty. Feedback forms for both the modules were mailed to all the participants after the end of half of the program to analyze the participants' satisfaction about the program and to help in further improvement of the program and the performance of the presenters. Most of the participants had given a satisfactory response, while few of them had added few suggestions. These were noted and were implemented in the subsequent sessions.

This program received an unexpectedly successful response from postgraduate students and practicing pathologists from 45 locations across India and also from 5 other countries. After the first session, the program had reached many other pathologists through word of mouth and there were more queries requesting to take new registrations. The last date of registration was extended and the session was taken again for the new participants. The current program is now running successfully. Many reputed pathologists from India and abroad, radiologists, and pulmonologists are getting associated with the program as Faculty Speakers and are voluntarily taking lectures and slide seminar sessions, thereby sharing their knowledge and expertise. Different companies are trying to collaborate with the club and have volunteered to offer free services like digitization of slides and offering platform for teaching the digitized slides. The current program gets completed in the month of April 2021. The program successfully created a positive impact in the participants, especially among the postgraduate students, who developed more interest in this sub-speciality and which was evident by their active participation in all sessions. It is the desired goal of Pulmonary Pathology Teaching Club to take this field to the next level by planning for more modules with advanced topics and conducting workshops and conferences. Collaboration of societies (clinical, radiology, and pathology) is very much required to meet this objective. If this is met, then Pulmonary Pathology in India could go a long way by overcoming the diagnostic challenges and hurdles faced in the present scenario.

“Vision is the art of seeing what is invisible to others” (Jonathan Swift). The club has seen the invisible and has begun on a journey less travelled to fulfill the desired vision much aspired. It has succeeded to give the students an appreciation of this sub-specialty whether or not they pursue it in their future practice.

References

1Bal A, Agrawal R, Vaideeswar P, Arava S, Jain A. COVID-19: An up-to-date review – from morphology to pathogenesis. Indian J Pathol Microbiol 2020:63;358-66.
2Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of Coronavirus disease 2109 (COVID-19): A review. JAMA 2020;324:782-93.
3Calabrese F, Pezzuto, Fortarezza F, Hofman P, Kern I, Panizo A, et al. Pulmonary pathology and COVID-19: Lessons from autopsy. The experience of European pulmonary pathologists. Virchows Arch 2020;477:359-72.
4Mujeeb Rahman KK, Samaria JK. Diagnostic delay and misdiagnosis in interstitial lung disease (ILD) at primary health care level. Eur Respir J 2016;48:PA861.
5Leslie KO. My approach to interstitial lung disease using clinical, radiological and histopathological patterns. J Clin Pathol 2009;62:387-401.
6Idris A, Edris B. Virtual medical education during the COVID-19 pandemic: how to make it work. Eur Heart J 2021;42:145-6.
7Samueli B, Sror N, Jotkowitz A, Taragin B. Remote pathology education during the COVID-19 era: Crisis converted to opportunity. Ann Diagn Pathol 2020;49:151612.

 
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