Dissecting the Pathology Gap in Osteopathic Education
By Harnoor Galani, B.S., B.A.
Pathology forms the foundation of modern medicine, guiding clinical decisions, confirming diagnoses, and shaping therapeutic direction. Yet, despite its central role in healthcare, it remains one of the most underexperienced fields for many medical students—particularly those in osteopathic programs. For students pursuing the Doctor of Osteopathic Medicine (DO) degree, limited access to pathology training during clinical years can hinder both understanding of the specialty and interest in pursuing it as a career.
This article explores the structural factors contributing to reduced pathology exposure among DO students, outlines the importance of integrating pathology into osteopathic curricula, and offers strategies to bridge the existing gap through mentorship, virtual learning, and curricular innovation.
Clinical Exposure in Osteopathic Schools
One of the most significant factors limiting pathology engagement among DO students, whose training includes learning osteopathic techniques, is the lack of structured clinical opportunities. A 2024 cross-sectional study examining all 61 COCA-accredited osteopathic medical schools revealed that only 12% had a pathologist in a dean-level leadership role, and many lacked full-time faculty in pathology altogether [1]. These institutional limitations often result in the absence of required pathology rotations, restricted access to autopsy suites or histology labs, and minimal integration of pathology into clinical learning environments.
Compared to their MD peers, DO students report fewer hands-on experiences with microscopy, gross specimen review, autopsy participation, or exposure to interdisciplinary case presentations involving pathologists [2]. As a result, pathology is often perceived as an academic subject rather than a clinical specialty. Without the opportunity to witness how a frozen section informs a surgical decision or how a hematopathologist contributes to a leukemia diagnosis, the specialty can remain abstract and esoteric.
The Role of Mentorship and Visibility
Mentorship and representation are critical factors in shaping specialty choice. In the same national study, osteopathic students reported lower rates of mentorship from pathologists and were less likely to feel that faculty actively encouraged interest in the field [2]. This lack of mentorship is compounded by the relative absence of pathology interest groups at many DO institutions, as only 38 percent of COM campuses have a pathology student interest group [1].
A visible, accessible community of professionals and peers can influence how students think about their future roles in medicine. When students encounter engaged pathologists who model diagnostic reasoning and communicate the clinical impact of pathology, the specialty becomes more tangible. In contrast, a lack of visible role models may limit both awareness and aspiration.
Educational Impact of Early Exposure
Exposure to pathology during medical education plays an important role in fostering student interest. Research has shown that students who participate in electives or research within pathology are more likely to consider it as a career [2,3]. Early experiences—such as observing an autopsy, sitting in on sign-out sessions, or reviewing histologic slides under supervision—can illuminate the diagnostic process and its value within patient care.
In addition to career impact, improved pathology exposure enhances clinical competency for all future physicians, regardless of specialty. Understanding how laboratory and tissue-based diagnoses are formed contributes to more effective patient management, stronger communication with multidisciplinary teams, and better clinical judgment overall.
Strategies to Expand Pathology Engagement
Virtual Platforms for Learning and Social Media
One solution to the access barrier is the use of virtual pathology platforms. PathElective.com, for example, offers interactive modules and virtual slide reviews that allow students to explore pathology from any location. These platforms are particularly useful for schools without on-site pathology departments, providing foundational exposure that complements clinical rotations and board preparation. Students of DO schools who do not have a pathology student interest group, can also sign up to be members of Pathology Student Interest Group (PathSIG), a free virtual interest group that is affiliated with PathElective.com and aims to increase medical students' exposures to pathology through webinars, review series, online meet and greets, etc [4]. In addition, social media platforms and hashtags, such as #PathTwitter, has progressively created online communities for pathologists and students to network both nationally and internationally [3].
Structured Mentorship and Fellowships
Osteopathic schools can benefit from identifying alumni, faculty, or community pathologists who can serve as mentors and advocates for the specialty. Virtual mentorship programs, guest lectures, and elective partnerships can help introduce students to the breadth of the field, even in resource-limited settings [3]. In addition, DO students interested in pathology as a career can pursue a post-sophomore or post-junior pathology fellowship, which are 12-month paid postgraduate year programs where students are trained as PGY1 residents and gain pathology experience at a residency program [3].
Integrating Pathology into Existing Clinical Rotations
Pathology does not need to be taught in isolation. Students can benefit from integrated experiences across core clerkships. For example, during surgery rotations, students may attend frozen section reviews. In internal medicine, exposure to transfusion protocols or tumor board discussions can reinforce pathology’s role in patient care. Embedding these experiences throughout the curriculum can strengthen diagnostic reasoning and deepen appreciation for the specialty.
Conclusion
Osteopathic medical students bring a unique, systems-oriented perspective to clinical training. This perspective aligns well with the field of pathology, which requires both analytical precision and a holistic view of disease. However, when pathology is kept out of view—both physically and pedagogically—it limits not only student understanding but also the future growth of the specialty itself.
By expanding access to virtual learning, fostering mentorship, and embedding pathology across clinical experiences, DO programs can give their students a clearer window into the field. The goal is not only to increase recruitment into pathology, but also to ensure that all physicians, regardless of specialty, are better equipped to understand and apply the science behind the diagnosis.
References
Preston, P., Herman, M., Berry, A., Robinson, M., Schukow, C. P., & Kowalski, P. (2025). A cross-sectional analysis of pathology exposure across COCA-accredited osteopathic medical schools: Gaps and opportunities in pathology undergraduate medical education. Academic pathology, 12(3), 100186. https://doi.org/10.1016/j.acpath.2025.100186
Holloman, A. M., Berg, M. P., Bryant, B., Dixon, L. R., George, M. R., Karp, J. K., Knollmann-Ritschel, B. E., Prieto, V. G., Timmons, C. F., Childs, J. M., Lofgreen, A., Johnson, K., & McCloskey, C. B. (2023). Experiential exposure as the key to recruiting medical students into pathology. Academic pathology, 10(2), 100074. https://doi.org/10.1016/j.acpath.2023.100074
Schukow, C. P., Herman, M., & Mirza, K. (2023). Osteopathic physician trainees and pathways to pathology. Academic pathology, 10(2), 100071. https://doi.org/10.1016/j.acpath.2023.100071
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