Leaders in Medical Education: Dr. Kristine Krafts, Founder PathologyStudent.com

Feb 22, 2016 by

Kristine Krafts, M.D. is an Assistant Professor of Pathology at the University of Minnesota School of Medicine and School of Dentistry. Before deciding to teach full time, Dr. Krafts completed a pathology residency and fellowships in hematopathology and molecular pathology. One of the things you will pick up very quickly on her website, PathologyStudent.com is the way she uses humor and her unique take on life to make pathology very memorable indeed.

I was first introduced to Dr. Kraft’s work through an invitation from a fellow med student to subscribe to her short daily ‘Path Bites’ newsletter. Despite her extremely busy schedule, she takes the time to answer comments on her newsletters and website.

Dr. Krafts creates materials for medical students, dental students, and allied health students. These include several pathology study guides, including four which are available for Kindle:

  1. The Complete (But Not Obsessive) Hematopathology Guide

  2. Clot or Bleed: A Painless Guide for People Who Hate Coag

  3. Path Bites Anthology, Volume 1: General Pathology

  4. Path Bites Anthology, Volume 2: Systemic Pathology

How did you get interested in pathology?
It took me a while to realize that pathology was what I found most exciting because I started medical school with the idea that I would be a primary care physician. I went to the University of Minnesota Medical School, Duluth Campus, for my first two years. Part of their mission is to train primary care physicians for rural areas, so that added another layer to my expectations about what I should do when I finished med school. I really liked pathology, but I dismissed the idea of being a pathologist because I had this vision of being in a white coat with a stethoscope around my neck, going from exam room to exam room, and seeing real patients.

But as I got into my clerkships in third and fourth year, I started ruling out specialties that I could see would not fit well for me. I started spending more time down in pathology getting information on whatever diseases my patients had – and I realized that I liked looking at beautiful things under the microscope. I also realized that most of the pathologists were well-rested, calm, and genuinely interested in their work.

It’s hard to change course and give up your preconceived notions about what you want to do with your life. But if the goal is to be useful and help others (which I think is what brings most of us to the medical profession), then the best way to achieve that is to choose to do something that you are good at and that brings you joy.

After completing a residency, and fellowships in pathology, what made you decide to teach? How was the transition from a clinical role to an academic role?
This was another slow process of realization for me. Like the decision to go into pathology, it involved setting aside existing notions about what I “should” do and looking at what I really enjoyed doing.

Most of my fellow residents planned to go into private practice and knew this from the very beginning of residency. We rotated through a few private practice groups during our residency, and it was pretty clear that the pathologists in those groups had different surroundings (big, paneled offices with wood desks and nice carpets) and different (bigger) salaries than those who worked in our institution. Their daily work was also different, of course – virtually all of it was clinical practice, with only an occasional lecture and very little interaction with students.

The longer I was in residency, the more I realized that what made me happiest was learning new things (and as a corollary, helping others learn new things). I had been lecturing at the Medical School in Duluth since I was in medical school (another long story), and adding a few lectures every year, just because I loved it and the Med School allowed me to do it. So by the time I finished residency, I already had a teaching load that was bigger than the average faculty load – and it felt natural to continue along that path and see if there was a way to make the position an official full-time one. Fortunately, the med school needed a faculty member in the pathology department, so everything worked out well.

I’ve talked with a lot of students about how to make the decision of what specialty to go into, and whether to follow an academic or private practice career. There is, of course, no one right answer, since everyone has unique talents and personalities. I think it’s really important to consider your gut feeling when it comes to this type of decision. Yes, there are practical considerations – the time constraints, the salary, the fit between the job and your personal/family life, your aptitude for that particular field – but there is also a quiet sense of “I love this” vs. “I should do this” that is there too. It’s almost heresy to say this in such a science-based field as medicine, but I think that quiet, inner knowing is at least as important as the louder, more externally motivated voice.

You teach both in the medical and dentist schools. How is the pathology experience different for each type of student?
That's a great question. It gets at something every lecturer should consider: why do these particular students need to know this particular material?

It’s easy to spend more time on the things you love to talk about. I know I have been guilty of that. It’s hard to pass over showing just one more slide of a beautiful eosinophil with gorgeous, luminous granules the color of a sunrise. And if you do research, it may be tempting to fit that into your lecture if it is even tangentially related to what you’re talking about.

But the teacher’s job is to teach the students the material they need to know (or at least guide them through it and show them how to learn). Since I was a medical student once, back in the stone age, it’s pretty easy for me to figure out what medical students need to know. But when I started teaching at the Dental School, I had to ask a lot of people – students, other professors, administrators, random dentists on the street – what material was important for them to know.

I came up with four reasons that dental students need to know any particular piece of pathology:

  1. It will help them provide the best treatment and care for their patients. For example, dentists should know the signs and symptoms of hyperthyroidism, because patients with severe hyperthyroidism must be treated with great care so as not to elicit thyroid storm.

  2. It could help the dentist pick up a medical problem the patient does not know is present. For example, a patient who hasn’t been to a doctor for years may have a worrisome-appearing mole on the cheek.

  3. It is something that is likely to be covered on boards.

  4. It is something that should be part of one’s general medical knowledge. For example, a patient – or family member – may ask the student (or dentist) what causes ulcers.

If a piece of information doesn’t fall into one of these four categories, it shouldn’t be in my lecture. And the last reason should be used judiciously, so it doesn’t turn into an excuse to put in stuff with no concrete purpose.

How can pathology be taught in a more fun way?
Another great question – and one that we should be thinking about no matter what subject we teach! It’s almost a no-no to say that lectures should be entertaining, but I don’t know why this should be the case. Why not?

We do all kinds of weird stuff in lecture that I suppose could appear frivolous – but there’s always a method to the madness. For example, I like to make mapo doufu for my class when we talk about hemostasis. Mapo doufu is an ancient stew containing a bunch of yummy ingredients like garlic, onion, tree ear mushrooms, and peppers. It is said to increase longevity, and this may be true, at least when it comes to strokes and heart attacks, since many of the ingredients have anti-thrombotic properties. I actually did platelet studies on my blood after eating a few bowls the night before, and my platelet aggregation was well below normal with many of the aggregating agents. Good thing I didn’t eat 5 bowls.

We also have a skit every year where the students put on costumes (they volunteer for different roles) and act out the drama of how the immune system attacks an invading organism. The weapons are unusual (the cytotoxic T cell uses a Manolo Blahnik high-heeled pump) but instructive.

Sometimes, you have to use your imagination in weird ways to get stuff into your head: we learn MEN I and II by using John Cleese and Brad Pitt as examples of the world’s sexiest men. I personally vote for John Cleese but am open to others’ opinions.

I try to do the same thing in my writing, and I think it makes learning pathology a lot more palatable (and easier, as a result). I use shoes to help students remember the intrinsic vs. extrinsic arms of the coagulation system (yes, it’s weird, but it works), and I like to write in a conversational style, as if I were talking to a student rather than writing an official textbook. It seems to work better that way. There are enough really good – and really voluminous – pathology textbooks out there; what students need is a way to make sense out of all that material, and try to remember at least some of it beyond exams.

Do you have any final thoughts regarding the Medical profession as a whole?
I do have one last thing that I want to mention, if there are any students who have read this far. Over the years, I have gotten a lot of questions from people who are not medical professionals but who have stumbled across Pathology Student. Many are searching the internet for answers and happened to find something on Pathology Student that made sense, so they write to ask more about a particular disease.

One thing that comes up over and over is their doctor’s ability and willingness to listen and to explain things and answer questions. Great doctors take the time to listen (it sounds trite, but it is true) – really listen – and explain what is going on so that the patient can understand and make decisions. It’s not something we talk a lot about in medical school (or dental school) but it is a huge thing for the patient.

So many students have a really genuine kindness and empathy – you can see it in the way they interact with other students and in the way they talk with professors. I see them and I think, that’s the kind of person I want for my own doctor or dentist. I hope they can identify those personal qualities in each other and are able to keep them intact as they move into patient care.