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I was talking to the coordinator of the pathology course a few weeks ago and he told me that while they are designing an overhaul to a systemic approach, the next few years will just have fine tunings of the current system. Hammel said that his goal is to get the general pathology course taught in a block at the beginning of first year, so that as you go about learning everything else, you already know the mechanisms for cellular and local injury and will make other things easier to understand.
Having shifted to a systems approach to review for the USMLE, I think that I'm glad to have learned the disciplines independantly and gotten a rough overview of everything before trying to integrate them together because very few things are limited to just one organ system.
For example, something as simple as Vitamin D.. do you teach it with MSCT (musculoskeletal connective tissue) because of the bones? Or do you teach it with GI because it's a fat-soluble vitamin and requires both pancreatic and colonic viability? Or do you teach it with Renal because of Ca2+ and PO4- balancing? And whichever you decide to teach it with, how are you going to understand the effects and influence it has the other systems you know nothing about yet?
So you can see the flaws in a systemic approach. Not to mention that with all the gaps and overlaps, things get overlooked. I notice that in my review.. Cholesterol synthesis is more pertinent to the pathology of the cardiovascular system but it happens in the liver.. so during CV I was like, screw it, I'll do it later.. and now I'm doing the liver and I'm like, crap, I wish I did it earlier.
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