Med intern on path rotation

chicamedica · Jun 17, 2006

Hey pathology SDNers! I am starting my intern year with a pathology rotation. I chose that as one of my electives because i had always wanted to do a pathology rotation but never got a chance to during med school. But now i realize that I have no idea what people do as interns on a path rotation. What would my role involve? How can I be as helpful as i can?

pathstudent · Jun 17, 2006

chicamedica said:
Hey pathology SDNers! I am starting my intern year with a pathology rotation. I chose that as one of my electives because i had always wanted to do a pathology rotation but never got a chance to during med school. But now i realize that I have no idea what people do as interns on a path rotation. What would my role involve? How can I be as helpful as i can?

You will be able do as much or as little as you like. You can probably not even show up and no one will do anything or think anything of it, or you can go full tilt grossing, previewing and going to sign-out, which they will think is very cool.

A lot of path residents find social interaction fairly difficult and tiresome and will be relieved if you just go away. Some are not like that and will do the best they can to engage you.

To be helpful, just be pleasant and have a good attitude. That will go far.

beary · Jun 17, 2006

pathstudent said:
A lot of path residents find social interaction fairly difficult and tiresome and will be relieved if you just go away.

yaah · Jun 17, 2006

chicamedica said:
Hey pathology SDNers! I am starting my intern year with a pathology rotation. I chose that as one of my electives because i had always wanted to do a pathology rotation but never got a chance to during med school. But now i realize that I have no idea what people do as interns on a path rotation. What would my role involve? How can I be as helpful as i can?

I'm not sure how helpful you can be. For certain surg path rotations, if you can look up clinical histories it can often help, although not always. As a resident, I don't really expect the med student or resident to do anything except sit there and learn. Part of the reason is that I never know when they are going to be there, so obviously I can't depend on them.

I would rather they spend time reading about cases or differentials instead of helping. It's good to ask questions, of course, but don't ask silly questions that slow down signout. (as in, "How do you grade prostate cancer" or "what's cancer.") If it is something you can look up easily, don't be afraid of books. But asking questions is almost always otherwise good though.

At most places, grossing specimens is not really an option unless you are a path resident. Just hang around and try to learn something.

chicamedica · Jul 1, 2006

Hey thanks guys for the tips. Just finished my first week on path. . .was on thoracic/surg path. It was a great week, awesome teaching by the attending, the fellow, and the resident on the team. I actually did get to gross specimens and even got to cut a frozen section! Not to mention learning tons by looking at slides with probably the world's expert in thoracic pathology.

Wow, I am really glad i'm not at your program yaah. If I had to be afraid to ask questions or spend my day looking up patient's histories or sent off to keep my nose in a book (which i can do in my down time or at home) instead of learning from the specimens & the team, i'd seriously walk out. What a waste of my time! I mean, occasionally we all had to look stuff up on some cases, like a CT scan to refer to a nodule or an H&P to see if a patient had a bicuspid aortic valve, which i was more than glad to do, but the intern isn't there to be sent off to look up all those histories while everyone else analyses the slides and the gross specimens. That's scutwork! Definitely makes me realize what a great place i'm at.

yaah · Jul 1, 2006

chicamedica said:
Wow, I am really glad i'm not at your program yaah. If I had to be afraid to ask questions or spend my day looking up patient's histories or sent off to keep my nose in a book (which i can do in my down time or at home) instead of learning from the specimens & the team, i'd seriously walk out. What a waste of my time! I mean, occasionally we all had to look stuff up on some cases, like a CT scan to refer to a nodule or an H&P to see if a patient had a bicuspid aortic valve, which i was more than glad to do, but the intern isn't there to be sent off to look up all those histories while everyone else analyses the slides and the gross specimens. That's scutwork! Definitely makes me realize what a great place i'm at.

Well, I think you're being a bit overdramatic here. Obviously, asking questions is encouraged. But at any program, if you ask questions like, "What's a prostate?" you are not going to get much of a response. And looking up clinical histories is not scutwork. It mostly depends on who is at the computer, actually. It can happen in the context of signout, or can happen before signout. You don't get sent off to do this. You don't spend your day looking up clinical histories. You can spend your day doing whatever you want, it's just that on path it is often more self directed, and you have to take the initiative.

The thing is, many med students use a path rotation as an opportunity to leave early, unfortunately. So when a new student comes in, we give them the benefit of the doubt, but we don't expect much unless they take more initiative. But when someone comes to signout or wants to look at cases on their own, they obviously will be given more of an opportunity. If they want to help out on autopsies, that's fine. If they want to try cutting a frozen, that's good.

The thing is, you asked the question, "How much help can I be?" and I answered. They are not letting you cut frozens or letting you gross things in to be helpful. I didn't mean to imply that med students should stay out of the way and go put their face in a book instead of actively participating. That's silly. What I am saying is that you (as a student) aren't necessary as useful on pathology services, as you would be on medical or surgical services, so don't worry about "helping" and worry more about learning. Learning can obviously include technical things such as grossing and frozens! No one is going to make students do objectionable tasks like going to deliver slides to someone or run errands or leave signout to go find another doctor. You do much, much, much less scut (actually, you do NO scut) on pathology rotations.

I'm sorry if you don't think reading and learning about cases is a reasonable assumption for a student on pathology. If you have sat in on signout at all, you will realize that being prepared for signout by reviewing the cases and learning about the differentials is extremely important.

I love it when a student is around who is interested in pathology and eager to learn. It makes things a lot more interesting, and I learn more when I can help teach. So sometimes I go over cases with the student before or after signout, etc. But that is the rare student!

1Path · Jul 2, 2006

yaah said:
Well, I think you're being a bit overdramatic here. Obviously, asking questions is encouraged. But at any program, if you ask questions like, "What's a prostate?" you are not going to get much of a response. And looking up clinical histories is not scutwork. It mostly depends on who is at the computer, actually. It can happen in the context of signout, or can happen before signout. You don't get sent off to do this. You don't spend your day looking up clinical histories. You can spend your day doing whatever you want, it's just that on path it is often more self directed, and you have to take the initiative.

The thing is, many med students use a path rotation as an opportunity to leave early, unfortunately. So when a new student comes in, we give them the benefit of the doubt, but we don't expect much unless they take more initiative. But when someone comes to signout or wants to look at cases on their own, they obviously will be given more of an opportunity. If they want to help out on autopsies, that's fine. If they want to try cutting a frozen, that's good.

The thing is, you asked the question, "How much help can I be?" and I answered. They are not letting you cut frozens or letting you gross things in to be helpful. I didn't mean to imply that med students should stay out of the way and go put their face in a book instead of actively participating. That's silly. What I am saying is that you (as a student) aren't necessary as useful on pathology services, as you would be on medical or surgical services, so don't worry about "helping" and worry more about learning. Learning can obviously include technical things such as grossing and frozens! No one is going to make students do objectionable tasks like going to deliver slides to someone or run errands or leave signout to go find another doctor. You do much, much, much less scut (actually, you do NO scut) on pathology rotations.

I'm sorry if you don't think reading and learning about cases is a reasonable assumption for a student on pathology. If you have sat in on signout at all, you will realize that being prepared for signout by reviewing the cases and learning about the differentials is extremely important.

I love it when a student is around who is interested in pathology and eager to learn. It makes things a lot more interesting, and I learn more when I can help teach. So sometimes I go over cases with the student before or after signout, etc. But that is the rare student!

chicamedica · Jul 5, 2006

yaah said:
Well, I think you're being a bit overdramatic here. Obviously, asking questions is encouraged. But at any program, if you ask questions like, "What's a prostate?" you are not going to get much of a response. And looking up clinical histories is not scutwork. It mostly depends on who is at the computer, actually. It can happen in the context of signout, or can happen before signout. You don't get sent off to do this. You don't spend your day looking up clinical histories. You can spend your day doing whatever you want, it's just that on path it is often more self directed, and you have to take the initiative.

The thing is, many med students use a path rotation as an opportunity to leave early, unfortunately. So when a new student comes in, we give them the benefit of the doubt, but we don't expect much unless they take more initiative. But when someone comes to signout or wants to look at cases on their own, they obviously will be given more of an opportunity. If they want to help out on autopsies, that's fine. If they want to try cutting a frozen, that's good.

The thing is, you asked the question, "How much help can I be?" and I answered. They are not letting you cut frozens or letting you gross things in to be helpful. I didn't mean to imply that med students should stay out of the way and go put their face in a book instead of actively participating. That's silly. What I am saying is that you (as a student) aren't necessary as useful on pathology services, as you would be on medical or surgical services, so don't worry about "helping" and worry more about learning. Learning can obviously include technical things such as grossing and frozens! No one is going to make students do objectionable tasks like going to deliver slides to someone or run errands or leave signout to go find another doctor. You do much, much, much less scut (actually, you do NO scut) on pathology rotations.

I'm sorry if you don't think reading and learning about cases is a reasonable assumption for a student on pathology. If you have sat in on signout at all, you will realize that being prepared for signout by reviewing the cases and learning about the differentials is extremely important.

I love it when a student is around who is interested in pathology and eager to learn. It makes things a lot more interesting, and I learn more when I can help teach. So sometimes I go over cases with the student before or after signout, etc. But that is the rare student!

Well that's good to hear, yaah. And i do think reading and learning about the cases is reasonable, just not at the expense of looking at and discussing slides or gross specimens with the team. The former should be done to have a background to discuss the latter. (Besides, the way we do it, is we look stuff up while looking at slides.)

And as an intern, "scut" on the medicine floors is not usually someone sending the intern off to do menial stuff while the rest of the team discusses and makes decisions. The intern does what needs to be done yes, including some menial tasks, but the patient is hers/his, and the intern is usually included in the discussions and decisionmaking. Unlike on path where it's very possible to just send the off-service intern off to do menial stuff like printing up paperwork and outlining specimens on slides, etc and exclude them from the analysis and discussions. That is what i mean by scut. Now i dont mind doing some scut to help out, IF i get teaching in return. And i've noticed that with certain attendings and residents, I do have to kinda start out prompting them to teach me (with questions!), otherwise, they'll just sit there in silence looking at the slides while I'm looking through the adjoining microscope head wondering what the heck that is!

BTW, (and this is directed towards a lot of people in path, as i've experienced) dont assume that if I'm going into another field, perhaps that doesn't really deal much with path, that I'm not interested in pathology. I may not be going into the field, but this is one of my only chances to experience this subject in hands-on form and it does actually deal with my specialty (and ANY specialty) indirectly. Furthermore, believe it or not, some people want to have a broad knowledge base and not limit their knowledge to just their specialty. We are PHYSICIANS first and foremost. It's better to give off-service residents rotating through the dept the benefit of the doubt and if they demonstrate they aren't interested, then feel free to back off.

yaah · Jul 5, 2006

chicamedica said:
BTW, (and this is directed towards a lot of people in path, as i've experienced) dont assume that if I'm going into another field, perhaps that doesn't really deal much with path, that I'm not interested in pathology. I may not be going into the field, but this is one of my only chances to experience this subject in hands-on form and it does actually deal with my specialty (and ANY specialty) indirectly. Furthermore, believe it or not, some people want to have a broad knowledge base and not limit their knowledge to just their specialty. We are PHYSICIANS first and foremost. It's better to give off-service residents rotating through the dept the benefit of the doubt and if they demonstrate they aren't interested, then feel free to back off.

That wasn't the assumption that I make. And it doesn't really influence people. What influences people is the assumption that some students are doing path rotations to take a vacation or leave early (an assumption that, is, unfortunately, too often valid). As I said, I and most people almost always give students the benefit of the doubt. But when they are asking the same questions on day 3 that they asked on day 1, and it is clear they are not doing anything other than sitting at the scope, it becomes less of a teaching opportunity.

In terms of broad knowledge base, that is the essence of pathology. As pathologists, we are basically required to know something about every branch of medicine, because our duties cover everything in some aspect. So I know more about medical renal disease than surgical residents, more about surgery than medical residents, etc etc etc. A broad base of knowledge is extremely important, as it is in every other field. But unfortunately in this era of increasing specializations and profit margins, that is becoming less important. As, at times, is actual knowledge. This dismays me, and is one of the reasons I am in pathology, because we spend less time with the bull****. In medical education schools seem to be taking away time in path labs, and actually learning about real disease and the reasons for things, in favor of touchy feely crap and small group sessions.

Almost every attending and resident I have ever met always comments favorably on the people in other specialties who show an interest in pathology and the issues that are important. Your assumption that a lot of pathologists don't care about other fields, or educating other physicians in other fields, is invalid. It makes our job a lot easier when a physician knows what we mean when we say things in reports.

1Path · Jul 5, 2006

chicamedica said:
And i've noticed that with certain attendings and residents, I do have to kinda start out prompting them to teach me (with questions!), otherwise, they'll just sit there in silence looking at the slides while I'm looking through the adjoining microscope head wondering what the heck that is!

I've sat in on many a sign out and have NEVER seen a quiet attending/resident at the head of the scope. The person at the head HAS to talk otherwise how will the other folks (like the surgeon for example) know what she is thinking in terms of Dx? At the very least they will pimp you (even lowly premeds) so there's always some sort converstion going on.

I imagine that a quiet pathologist probably needs an autopsy!

chicamedica · Jul 5, 2006

1Path said:
I've sat in on many a sign out and have NEVER seen a quiet attending/resident at the head of the scope. The person at the head HAS to talk otherwise how will the other folks (like the surgeon for example) know what she is thinking in terms of Dx? At the very least they will pimp you (even lowly premeds) so there's always some sort converstion going on.

I imagine that a quiet pathologist probably needs an autopsy!

Yeah i mean, it depends on the attending. . . The pathologist i'm working with now tends to look at the slide in silence and then put it away and discuss his overall impression (which usually consists of agreeing with the fellow's written findings). He makes sure to make some teaching points now though since i started asking questions. However, I do try to judge whether we are pressed for time to get through all the cases, in which case I try to be understanding about the less amt of teaching and I refrain from questions.

chicamedica · Jul 5, 2006

yaah said:
That wasn't the assumption that I make. And it doesn't really influence people. What influences people is the assumption that some students are doing path rotations to take a vacation or leave early (an assumption that, is, unfortunately, too often valid). As I said, I and most people almost always give students the benefit of the doubt. But when they are asking the same questions on day 3 that they asked on day 1, and it is clear they are not doing anything other than sitting at the scope, it becomes less of a teaching opportunity.

In terms of broad knowledge base, that is the essence of pathology. As pathologists, we are basically required to know something about every branch of medicine, because our duties cover everything in some aspect. So I know more about medical renal disease than surgical residents, more about surgery than medical residents, etc etc etc. A broad base of knowledge is extremely important, as it is in every other field. But unfortunately in this era of increasing specializations and profit margins, that is becoming less important. As, at times, is actual knowledge. This dismays me, and is one of the reasons I am in pathology, because we spend less time with the bull****. In medical education schools seem to be taking away time in path labs, and actually learning about real disease and the reasons for things, in favor of touchy feely crap and small group sessions.

Almost every attending and resident I have ever met always comments favorably on the people in other specialties who show an interest in pathology and the issues that are important. Your assumption that a lot of pathologists don't care about other fields, or educating other physicians in other fields, is invalid. It makes our job a lot easier when a physician knows what we mean when we say things in reports.

I know yaah, i wasn't necessarily describing you, however, more than one resident/faculty member on my rotation was surprised as to why on earth i'd be interested in taking a pathology rotation if i'm going into anesthesiology. I just cant understand their surprise! So if i'm going into anesthesiology, that means i cant' be curious about the rest of what medicine is about?? I do know that pathology involves a HUUUUGE knowledge base, but does that mean physicians in other specialties shouldn't develop a broad knowledge base? I for one would like to.

I do realize that some off service residents or medstudents take pathology for "vacation time". Unfortunately this has caused pathology people to assume all who aren't going into pathology are there for vacation time. In the beginning of my rotation, I did not feel that i was given the benefit of the doubt of being interested in learning pathology. I've definitely had to prove my genuine interest before people started taking me seriously and actually involving me and teaching me. I guess i'm just really appalled that many med students and off-service residents have no interest in learning path material, but it may be a vicious cycle at this point wherein the pathology people exclude them to begin with unless they are pretty darn assertive, so those who aren't so assertive may just not realize how fascinating this material is.

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