3rd and 4th year prep for path?

[quepatho]

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I just finished my second year of med school and I think I might have an interest in pathology (I did research in a pathology lab over the summer between my 1st and 2nd year, and I've been taken some time to see what the path residents at my school do. Seems neat.)

Assuming 3rd year doesn't totally change my mind, what sort of electives/rotations would be good to take? Any thoughts about externships or how I would begin to go about looking those up?

Also, I realize this shouldn't matter so much, but it's bugging me right now - I talked to the 3rd year director for rotations at my school, and not only did he have no idea what the components of the pathology residency were (i.e. basic terminology like AP and CP were lost on him - at least I thought it was basic???), but he essentially deprioritized me because he said "anyone can get into path, that's a joke. Generally you don't have to be very bright to go into pathology". Anyway, I don't think I'm going to get very good advice or scheduling help from him. Is this a common attitude among clinicians re: pathologists? Is it common for doctors in other specialties to not know much about pathology? Most importantly: is this a problem? 😕

Sorry if these questions have already been asked...sorry if there are too many questions in one thread...

 

[Ombret]

It's great to hear you're interested in path. Ignore your rotation advisor; how much are you going to rely on the opinion of someone who has no idea what he's talking about? Hopefully this is not the same person who will end up writing your dean's letter. His attitude is not all that common, but yes, some of these ideas are still out there. You will face interspecialty sniping no matter what field you go into.

You need to talk to the pathology faculty at your medical school and ask them about ways to spend time in their department. Most departments will offer a few different med student electives. My personal bias is that a surgpath elective, preferably one where you actually get to cut tissue, will give you the best exposure to what residency is like and help you figure out if you like this kind of work. Autopsy might be OK too. CP or observational rotations do not really let you prove yourself. Just my opinion (but I am AP oriented to begin with).

External rotations are probably not mandatory. Whether you do one (or more) and where will depend on where you are and what you want. Your path faculty members will have the best sense of how to advise you on this. Now if THEY tell you to shove off... by all means come back, because people here will have plenty of suggestions.

 

[KCShaw]

👍

There's a pretty recent thread around here about (mis)perceptions by other clinicians regarding pathology. There's also been some recent threads including discussion of electives for people wanting to go into pathology. I encourage searching those out for a read.

Basically, I think a priority would be to do a month in a working surg path department -- local is probably easiest and most effective, especially if they have a pathology residency, as you'll at least see what the program entails AND you can find a more suitable advisor if you decide to pursue pathology. Unfortunately most medical schools epically fail at giving students any realistic idea of what an AP/CP pathologist is or does, though equally not many pathologists at such institutions push their way into the curriculum beyond a requested pathophysiology or histology talk here or there...so there's enough shame to go around.

 

[BU Pathology]

Most medical schools will have a field specific advisor, a faculty member in a specific field who can provide advice. Typically this will be a person working in the specific field who is knowledgeable about the discipline, qualifications for getting into residency programs and which programs are strong.

You should ask about the field specific advisor for pathology and go see her/him for advice.

For rotations, I usually recommend only 1 or at most 2 rotations in pathology. You have years to train in pathology, use the last year of medical school to round out our education. Rotations such as radiology, dermatology or ER are usually useful for your later career (ER because you are still an MD).

Dan Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston University School of Medicine and Boston Medical Center

 

[lipomas]

I think Dr Remick makes a good point - people make the mistake of doing too many rotations in their field of choice during med school. Surgeons are probably the worst offenders. Fourth year is for preparing for residency, yes, but it is also for exposing yourself to other fields so you can learn different perspectives. No one expects you to know anything significant when you start pathology residency.

 

[quepatho]

Thank you all for your advice. I do have mandatory surgery, ER, and radiology rotations in any case* (I think I have a total of 82 to 84 weeks of mandatory rotations between 3rd year and 4th year). Maybe I can try to add a dermatology elective to the list - it's only two weeks at my school and it sounds interesting on its own. Does that sound like a reasonable plan?

I'll look up surgpath to see what's involved with that - the third/fourth years at my school have said that surgpath is not very organized at my school, but that hematopath is much more organized and well-taught here. Maybe if I do an externship I can try to get some surgpath experience during that time?

Re: the posters who suggest not taking more than 1-2 electives in pathology in order to not sacrifice breadth for depth - is your opinion at all changed by the fact that I have 80+ weeks of required rotations? My closest friend at another school said he only had 62 weeks of required rotations.

And yes, I will try to find a different adviser in the pathology department, hopefully in the coming months. My first pathology elective will be 2 weeks starting the first week of September (I have to plan it this way for various scheduling reasons). Hopefully I will be able to find a mentor during that time.

Thank you all for your advice! 😀 I really appreciate the suggestions very very much! I only get one shot at the next two years so I want to look back without regrets.

*Surgery is 8 weeks and radiology and ER are both 4 weeks.

 

[KCShaw]

... I only get one shot at the next two years so I want to look back without regrets. ...

I think more people look back and think about things they didn't do and will never get a chance to do again than look back and wish they had done another month of what they've done ever since.

Personally I recall having 3 months in which to do at least 2 acceptable electives and have a last "summer vacation" if we wanted it. Some people did 3 electives, others a couple of 6 week electives, and some found some weak but accepted electives where they could mostly goof off or finish after 2-3 weeks. That's not a whole lot of time to do things you might otherwise have no dedicated exposure to -- pathology, radiology in some cases, various specialty or subspecialty disciplines one would otherwise only deal with by consult, etc. Personally I did pathology and trauma rotations, and mixed in some vacation time. Everyone's different, and should be.

 

[Autopsy Sweet]

Thank you all for your advice. I do have mandatory surgery, ER, and radiology rotations in any case* (I think I have a total of 82 to 84 weeks of mandatory rotations between 3rd year and 4th year). Maybe I can try to add a dermatology elective to the list - it's only two weeks at my school and it sounds interesting on its own. Does that sound like a reasonable plan?

I'll look up surgpath to see what's involved with that - the third/fourth years at my school have said that surgpath is not very organized at my school, but that hematopath is much more organized and well-taught here. Maybe if I do an externship I can try to get some surgpath experience during that time?

Re: the posters who suggest not taking more than 1-2 electives in pathology in order to not sacrifice breadth for depth - is your opinion at all changed by the fact that I have 80+ weeks of required rotations? My closest friend at another school said he only had 62 weeks of required rotations.

And yes, I will try to find a different adviser in the pathology department, hopefully in the coming months. My first pathology elective will be 2 weeks starting the first week of September (I have to plan it this way for various scheduling reasons). Hopefully I will be able to find a mentor during that time.

Thank you all for your advice! 😀 I really appreciate the suggestions very very much! I only get one shot at the next two years so I want to look back without regrets.

*Surgery is 8 weeks and radiology and ER are both 4 weeks.

If the pathology experience is lame where you are then consider an outside elective nearby where you can get a different perspective. You may be limited on the number of outside rotations you can do, but it's always good to see how other labs operate.

I also agree with KCShaw that you should do a couple of pathology rotations but not much more than that. You need letters, and this is how you get them. You also need some experience to decide if it's what you want to do, so the two months are necessary. Beyond that, I would recommend you taking advantage of the opportunity (that you'll never have again) to do rotations in other specialties....ER, surgery, derm, are all great. Also consider a month or two more of a medicine specialty (infectious disease, nephrology, hepatology, etc) and try to focus on how pathology interacts with these while on the rotation. You can still get a lot of path experience even when you're not doing a path rotation just by letting your attendings and upper levels know you like it. I was constantly being asked to go to path to get a report or follow up on a case because I was the one who liked it, and knew where the lab was. 🙂

As far as clinicians go, many don't understand what we do (the previously mentioned thread is comical to read). So, we will continue to try and educate them.

Best of luck!

 

[zao275]

I agree with Autopsy Sweet: let your other attendings know of your path interest and many of them will find ways to make their specialty relevant to a pathologist in training (or at least they will allow you to do so). Derm is a great idea, and fun (but, as a dermpath, I am biased).

Jerad

 

[Autopsy101]

I found oncology a very useful 4th year elective. It allowed me to see things from their perspective and understand what information was important to include in reports. (This was before the implementation of templated reporting). Whenever I am getting harassed for reports on admitted patients, I just think of my experiences rotating on the oncology service and how stressful it was for me to keep rounding on the anxious patients every day when the pathology results were still pending.

 

[quepatho]

Thanks for all the advice 🙂 I really appreciate it.

I think more people look back and think about things they didn't do and will never get a chance to do again than look back and wish they had done another month of what they've done ever since.

I will certainly keep this in mind.

If the pathology experience is lame where you are then consider an outside elective nearby where you can get a different perspective.

Best of luck!

Thank you - there are two locations I can do pathology rotations nearby and I 'm going to try to take advantage of both of them. I can only do two weeks at each one, though. Hopefully, if I do that and an externship, that will be enough to give me an interesting and varied exposure.

Let your other attendings know of your path interest and many of them will find ways to make their specialty relevant to a pathologist in training (or at least they will allow you to do so).

I appreciate your advice - I just hope none of the clinicians I have for 3rd and 4th year decide to underestimate me because I have a declared interest in pathology - for some reason, I've been getting *systematically* negative/surprised reactions to declaring my interest in pathology (repeatedly). I guess I have to declare my interest with confidence and enthusiasm instead of tentatively explaining my interest and waiting for the inevitable disappointed "oh so you don't want to see patients?". I wonder if the radiology applicants get the same sort of negativity.

I found oncology a very useful 4th year elective. It allowed me to see things from their perspective and understand what information was important to include in reports. (This was before the implementation of templated reporting). Whenever I am getting harassed for reports on admitted patients, I just think of my experiences rotating on the oncology service and how stressful it was for me to keep rounding on the anxious patients every day when the pathology results were still pending.

I liked both derm and oncology a LOT this year. I did well in both, too - I will definitely keep oncology in mind as a rotation if I can get it. My preceptor for the first two years was an oncologist so I certainly appreciate how difficult his role can be.

My summer research at NIH was related to cancer pathology, too, and it really made me think very hard about how different disciplines interacted - I would hear a clinical story from the oncology attending who had followed the patient and then the resident performing the autopsy would explain his/her findings. I was totally blown away by how they worked together to "put together the picture of what must have happened" especially as a fairly naive first-year med student.

 

[rockit]

I agree that 1 or 2 path rotations is enough. For your electives, relevant topics in pathology are heme/onc, ID, and subspecialized surgery. I would stay away from other medical subspecialties, because you a lot of cards, renal, pulmonary, endocrine...will be at most tangentially relevant to path. Learn about tumors and surgery. Those are the major things we deal with daily.

 

[zao275]

...I guess I have to declare my interest with confidence and enthusiasm instead of tentatively explaining my interest and waiting for the inevitable disappointed "oh so you don't want to see patients?"...

Exactly! Show them why they are wrong about pathology/pathologists.

 

[lipomas]

Just consider it a flattering comment if they want you in their field. They probably like their field, otherwise they wouldn't want you in it. And they want more people they like to work with. Pathologists are the same. If practicing pathologists had more contact with med students these days, they would probably say the same thing. it's a shame you're not going into pathology with your eye and inquisitive mind, instead of pediatrics.