Introduction to Selected Reviews Based on the Massachusetts General Hospital, Harvard Medical School Postgraduate Course: “Current Concepts in Surgical Pathology”

We are pleased to bring to readers of the Archives reviews that are based on contributions prepared to accompany talks given at the 28th annual postgraduate course “Current Concepts in Surgical Pathology,” organized by the Department of Pathology, Massachusetts General Hospital, under the auspices of the Department of Continuing Medical Education of Harvard Medical School. Before we make a few remarks on the course itself, we will make a few brief comments on the history of these exercises, and the tradition of postgraduate education in general, which we hope will be of interest to many readers.Postgraduate pathology education dates, in large measure, back to the learned pathology societies of Europe, which in the late 19th century began to have frequent meetings, the proceedings of which were published as “Transactions” and are still an enjoyable and instructive read, stumbling as one often does on the words of the past giants. As Dr Juan Rosai discussed in a talk at the meeting of the History of Pathology Society at the last (2007) meeting of the United States and Canadian Academy of Pathology in San Diego, the tradition of slide seminars has been an arm of pathology postgraduate education for at least 50 years in the United States. The well-known Case Records of the Massachusetts General Hospital are, of course, also vehicles for education of those in their postgraduate years, as well as others.Continuing Medical Education courses in our department date back to a course on endocrine pathology that Dr Benjamin Castleman, Dr Austin L. Vickery, Jr, and Dr Robert E. Scully and others first organized circa 1960 (interestingly, 8 years before the Department of Continuing Medical Education at Harvard Medical School was founded) and ran successfully for about 15 years. It was very labor intensive due to the preparation of slide sets for study by the participants and was stopped largely for that reason, but it was soon replaced by a course on obstetric and gynecologic pathology that continues to this day. That was soon followed by the first offering of the “Current Concepts in Surgical Pathology” course covering all areas of surgical pathology, and one of the course directors (E.J.M.) has lectured at each of the 28 installments. A number of other courses of subspecialized nature ensued and have now been instituted for some years, including gastrointestinal pathology, obstetric and gynecologic pathology, urologic pathology, dermatopathology, and asbestos-related lung disease. A few of these courses have been jointly organized with our fellow Harvard Medical School faculty at the Brigham and Women's Hospital. More recently, courses in breast pathology and thoracic pathology have been given conjointly with colleagues at Memorial Sloan-Kettering Cancer Center in New York City.We currently offer the “Current Concepts” course every November, and selected proceedings are given here. Pathology courses can be aimed at several levels, ranging from highly selected areas directed at a small number of expert practitioners or investigators to more broadly based courses aimed at either investigators or practitioners at academic or nonacademic affiliated hospitals. This course has been aimed primarily at the latter, with particular emphasis on encouraging fresh approaches to recurring problems across the spectrum of anatomic pathology. The course has steadily attracted between 150 and 200 participants over the years. The field of surgical pathology is well suited for postgraduate courses since, as opposed to information that can be disseminated at courses for internal medicine or surgery in a theoretical manner, images and glass slides as depicted at pathology courses are our primary database, and a pathology course thereby is a very direct method of education. As our course has suggested since its inception, the hematoxylin-eosin slide will still be in play after the great majority of results currently dominating pathology journals will be footnotes.The conventional courses that we are all familiar with will likely be the mainstay of this type of activity for years to come. There is something about the educational value of hearing a good speaker in person that is not likely to be surpassed for the foreseeable future, associated as it is with the opportunity to ask questions informally or formally. Furthermore, for the majority who are not from the area where the course is being given, the attraction of taking a course in a pleasant location away from the demands of daily practice provides a welcome break from the routine. The aforementioned comments notwithstanding, it is clear that modern technology will enhance and to some degree alter these offerings as the years go by, and indeed that has happened already to an extent. Digital images on CD-ROM are already part of many courses or are available for an additional fee, although the extent to which these are widely used by registrants after the course remains an open question in our minds. This year, the slide seminar sessions will be available online in a format such that persons will not only be able to see the slides but hone in on selected areas of the slide at increasingly high magnification. The course itself will also be online with video and audio streaming. The range of the Internet both in terms of advertising and disseminating information must have increased the visibility of the course, as one third of our attendees now come from abroad.We have selected contributions in areas that provide frequent and recurring problems in daily practice of surgical pathology or in some instances are simply the source of new concepts or innovative approaches. We hope the reader enjoys the articles.

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