Integrating autopsy-based digital case resources into undergraduate pathology teaching: a two-cohort controlled study in cardiovascular pathology

Pathology teaching often remains fragmented, with limited support for clinicopathological reasoning and integrated understanding of disease. We developed a teaching model based on autopsy-derived digital case resources and examined its association with stage assessment performance and intervention-group learning perceptions across two independent cohorts of undergraduate clinical medicine students in a cardiovascular pathology. This two-cohort controlled educational study was conducted in the undergraduate cardiovascular pathology module. Cohort 1 included 87 students in the intervention group and 87 in the control group; cohort 2 included 134 students in each group. The intervention used a four-step model consisting of case introduction, lesion observation and analysis, clinicopathological correlation, and summary and reflection, supported by autopsy-based digital case resources before, during, and after class. The control groups received conventional lecture-based teaching supported by static pathological images and routine slide observation. Outcomes included stage assessment scores for both groups, an anonymous post-course questionnaire completed by intervention-group students across eight learning domains, and a keyword-based thematic analysis of their learning experience. In cohort 1, the mean stage assessment score was higher in the intervention group than in the control group (85.40 ± 15.61 vs. 78.05 ± 22.82, P = 0.014, Cohen’s d = 0.38). The same between-group pattern was observed in cohort 2 (86.64 ± 15.07 vs. 79.48 ± 22.62, P = 0.003, Cohen’s d = 0.37). In the pooled analysis, participation in the intervention group remained associated with higher scores (86.15 ± 15.26 vs. 78.91 ± 22.66, P < 0.001, Cohen’s d = 0.37). The group-by-cohort interaction was not statistically significant ( P = 0.960), providing no evidence that the between-group difference in stage assessment scores varied across cohorts. Among intervention-group respondents, the most consistently highly rated domains across both cohorts were clinicopathological correlation, diagnostic and differential reasoning, and understanding of disease processes. The thematic analysis showed differing emphases between cohorts: interest- and practice-oriented expressions were more frequent in cohort 1, whereas thinking-, integration-, and discussion-oriented expressions were more frequent in cohort 2. The overall autopsy-based digital case resource teaching model was associated with higher stage assessment scores across two cohorts. Intervention-group students reported positive perceptions of clinicopathological correlation, diagnostic and differential reasoning, and understanding of disease processes. The model may be a practical approach to support pathology-specific reasoning and more integrated learning, although causal effects cannot be established from this non-randomized study.