Bottom Line: The authors created a “Pathways Service” to link patient care to scientific inquiry by attempting to fill gaps in knowledge regarding the biology behind patients’ medical problems. Residents refer patients on their service to the program “if they have an extreme or unusual disease phenotype that no one has been able to explain adequately and if the disease process appears to reflect a fundamental pathophysiological problem.” Patients are chosen if a determination is made that there is a “potential for elucidating the underlying pathophysiology.” Residents on the Pathways rotation, along with the faculty advisor, “meet the patient, review data, and formulate pathophysiological hypotheses that they discuss with basic and clinical scientists from around the world.” The residents present the case at a Pathways conference. “After debate about the possible underlying mechanisms and potential experiments, the team agrees on recommendations for further clinical workup and a road map outlining feasible scientific explorations that may advance understanding of the fundamental problem.”
Armstrong K, Ranganathan R, Fishman M. Toward a culture of scientific inquiry – the role of medical teaching services . N Engl J Med. 2018 Jan 4;378(1):1-3.