Discouraged

[gungho]

---

Members don't see this ad.

Any other first-years out there besides me who are wondering if this stuff is ever going to make sense, if there is any way to, perhaps not master, but at least get comfortable with so much material? Is it just a matter of repetition, sort of "if you throw enough mud up against the barn wall, some of it's gonna stick"? Six weeks into this and I really enjoy it, but it looks insurmountable at this point. Any words of wisdom from the PGY-2 thru 4's?

 

[joedogma]

As an MS4 I can only speak from what I have heard from other residents and attendings...Pathology has the steepest learning curve of all specialties. Medical school doesn't really prepare you for the day in, day out activities of a pathologist so while you have to acquire a huge amount of material, you also have to "learn" how to be a pathology resident. From residents I have talked to, they tell me that it can take up to 8-12 months before you feel comfortable with your role in the department. This is why incoming residents who have done a PSF have an advantage (I really wish I did one). The first years at the program I just rotated through pretty much feel the same way you do but they get encouragement from the upper classmen. I suspect all these concerns and worries are completely normal...

 

[yaah]

As strange as it sounds, a lot of it is about repetition. It's tough when you start out, because not only is there so much to learn but it's like a different language.

I had a similar feeling this morning - I was looking at placenta slides, and trying to figure things out. And in looking for good reviews of placental histology and pathology, over the past couple of weeks I have found a 100 slide study set with guide, chapters in dozens of surg path and histology books, and 700 page books dedicated solely to placental pathology. And this is just a part of it all. Every branch of path has its own standard textbook. You can read a chapter on the liver in Sternberg, for example, think that it is way too much to ever master, and then realize that there is a 700 page book on JUST the liver.

I don't think it's reasonable to expect to learn a ton right away. A lot of it is learning the basics, and learning HOW to look things up, or where to start when you hit a wall.

Having done a year of AP, for the first 3-4 months it was incredible. Not only did you have to learn about all these diseases, but you had to learn how to describe them in a dictation, how best to demonstrate it on a slide, and how to interpret the slide. But gradually it started to click and you can focus less on the technical and procedural aspects and start to learn more. Go about it systematically, I guess. Try learning about new things every day, but don't try to be an expert in everything right away. If you see something you have never heard about or don't understand, read about it. Then you'll see it again and still be somewhat confused, so you read about it again.

Autopsies are similar - don't know if you have done those yet - but all of a sudden you are flooded with anatomy and dissection and somehow expected to know it. The good thing about path is that there is almost always someone around to help you understand and learn.

Clinical path too - just when you realize that AP has boatloads of stuff to learn, there is also CP where there is almost MORE information.

JoeD is right - it takes a lot of time to become comfortable, and when you do become comfortable, a lot of it is that you still don't know a ton, but at least you know how to find the answers.

Glad to hear you're enjoying it though - me too!

 

[Matte Kudesai]

Yeah the learning curve is high. I have talked to residents that have weathered surgical pathology successfully and am trying to listen to their advice.

WHEN YOU HAVE TIME:

Read, read, read..... Either Sternberg or Rosai.... Pick a book and read the heck out of it. You have a year.

Also try some good unknown websites like the following from Hopkins.

http://pathology2.jhu.edu/sp/

Reinforce your reading with online unknown cases in the category you are reading and/or look at your departments unknown slide collection.

I am trying to do this. It is not easy but I have already noticed a difference in my pattern recognition capabilities.

Also learning how to describe slides is something that comes with signing out, listening and learning.

EVERYONE STRUGGLES WITH THIS....
You are by no means alone.

I think Surgical Pathology has the highest leaning curve and the most brutal schedule.... but it's awesome.

 

[deschutes]

Funny how it's both unnerving and comforting to read about PGY-1 struggles.

Seems like at every stage of training (...and isn't medicine school for life...) people tell you not to worry, you'll never know everything - and yet how do you know that you know enough?

My prof said,"When you are a student, 'I don't know' is a statement of ignorance. Once you get your professional qualification, it becomes a consultant's opinion."

And I'll stop there before the thread derails.

 

[gungho]

Thanks for the comments. I guess having been in clinical medicine for so long and experiencing some degree of success and proficiency, it's a bit of a shock to be back at square one again; though I anticipated it, the reality is different from the anticipation. I will press on.

 

[PsychMD]

Hi, gungho! Are you currently enrolled in your second residency (Path), after practicing clinical for a while?

While you seem to be looking for mentorship regarding residency issues, I'm looking for advice re. transitioning from clinical practice to a second residency in Path. Anyone else who had the experience of going from clinical practice to a second residency in Path, please feel free to chime in.

Did you go through the match? How was your experience during interview season? Did you get grilled a lot re. "why the switch"? Anyone discouraging you during the process? (too "old"? "bleak job prospects outlook"? "medicare doesn't pay for a second residency"?, etc.). How did you go about getting references? Did you have to grapple with relocation issues too, or are you in your own hometown? Any other thoughts of wisdom that might alleviate some of my anxiety about the whole process?

I loved "yaah"'s comment about having to learn a "new language". Actually, this is one of the chief (rather selfish, I plainly acknowledge) personal motivations that are driving me at this point. 🙂

 

[gungho]

PsychMD,
I PM'd you to keep from making everyone else read stuff I've put here before. Anyone else interested, feel free to PM.

 

[pathdawg]

Pathology is indeed the steepest of all learning curves. Medical school does not prepare one to be a pathology resident. Pathology residency does really prepare one all that well to be a pathology attending for that matter. It takes years of experience. My residency director once told me that one should not be considered an "experienced" pathologist until they are 7-8 years out of residency/fellowship. At the time I thought that was excessive but I now realize how true that is (I've been in practice for four years, btw).
My advice is to not be overwhelmed by the volume of information before you. Learn as much as you can every day and look at as many slides as possible. Remember, this is the trade-off for the great lifestyle--pathology is hard. Don't worry. You'll get it.
Good luck.

 

[desmangt]

Also too, don't forget that you won't be completely on your own for a long time. Even if you do get a job at some small community hospital in rural America, you still can send the case off for a consult. I think you still get paid in the process. Correct me if I'm wrong. Alot of community hospitals and private practices have several pathologists who will work as a team and aid in diagnostic decisions, "quality assurance" sessions at some point in the day for difficult cases. But sadly, big volume is the best way to grasp all of this and that can mean harder work during residency or a longer, less intense, residency (with a couple fellowships). By the way, some of those websites like webpath are really awesome for getting a basic grasp on AP. I encourage 4th year med students to really use this while on path rotations. It will make your rotation very high yield and give you a running start when PGY-1 comes around.