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- Jan 7, 2009
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As an incoming PGY1 for pathology I have a question concerning level of preparedness. I have a very good grasp of the essential concepts, but no matter how many photomicrographs I look at, I still am struggling in applying my knowledge in making proper identifications. For example, I know the theory of how dysplasia should look like (both architecturally wise and nuclear changes) and how it differs from reactive changes and how high grade and low grade dysplasia can be distinguished from each other. However, I am still facing difficulty in properly identifying those features, especially the nuclear changes. Even if the text says normal or negative for dysplasia, I still manage to find what looks to me like nuclear enlargement, hyperchromasia, pleomorphism and loss of polarity. And even though the text may say high grade dysplasia or carcinoma in situ, I still manage to see nuclei that are uniform, basal and with their long axis perpendicular to their basement membranes, thus still having polarity. Therefore, I worry that my eyes are not yet prepared for pathology residency. How problematic is this and should I warn my program director before I begin? Thank you.