Problem with Pathology

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pathdude999

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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.

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Sounds like you're worrying prematurely. I'm pretty sure you are supposed to learn that stuff in residency. At this point (MS4, matched!!!), I'm proud of myself when I can tell what organ I'm looking at. And I do not intend to use my brain one single bit from now until July 1. :cool: I think your PD would laugh at you if you called to "warn" him/her. Relax! Take life easy!
 
I agree that pathdude999 seems to worrying prematurely. I think many of us newly matched are anxious about learning a new set of skills and embarking on a new career and whether we can live up to our expectations.

Did the current residents feel the same way when you started?

In the mean time ....pathdude999... you could rule out if you are having problems because of poor vision/color blindness etc
 
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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.

Welcome to the club.

Pathology is in large part about threshold and experience. In truth, the actual difference between "benign" and "dysplastic" is when a pathologist calls it one or the other. And pathologists may disagree with each other on this.

When you start learning, it is best to try to appreciate as many of these features as you can, and come to your own conclusions. If an experienced eye tells you you're wrong, learn why and you will modify your criteria. Soon it will start to click.
 
Thanks for the advice. Actually, I've been meaning to see an ophthalmologist to make sure I do not have any color blindness. If I am diagnosed with color blindness, is this something that could present difficulties for me as a pathologist trainee? Could it be grounds for dismissal from the residency? I've been putting it off actual because I am scared to know. Ignorance is bliss.
 
Thanks for the advice. Actually, I've been meaning to see an ophthalmologist to make sure I do not have any color blindness. If I am diagnosed with color blindness, is this something that could present difficulties for me as a pathologist trainee? Could it be grounds for dismissal from the residency? I've been putting it off actual because I am scared to know. Ignorance is bliss.

I've heard of color blind pathologists before. Besides...most of the older pathology textbooks were black and white photos. I don't think color matters so much as does morphology and intensity of the stain.
 
Well, you would have trouble with reading FISH studies, if you had to. But that's pretty minor. Other than that I think you could probably manage, it's all in what you get used to. The only way to tell is to go look at a lot of slides and see.
 
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