Do Med student vs PA histopathology curriculum

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wolves42

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I know there are endless “PA vs MD/DO curriculum” threads out there, but this is something I’ve never figured out

Do PAs just skip anything related to a microscope? Can PAs read peripheral smears? I was studying with a PA friend and she looked at my computer, and I had a picture of a lymph node biopsy with Hodgkin’s lymphoma and she said “ew why do you even have to know that”. She’s a first year PA student so she said she didn’t learn this yet but I’m kind of wondering if she ever will? But I didn’t wanna be a jerk and ask. But fr if i showed a PA a peripheral smear would they be able to point out an eosinophil? I if I showed a light microscopy image of PSGN would they be able to tell that it’s a glomerulus?

They always say they learn everything we learn in 1/2 the time but I feel like not knowing what blood or lymphoma or a Pap smear looks like is kind of... odd...

Imagine doing a Pap smear but having no idea what a koilocyte looks like. Even in primary care, not being able to distinguish bacterial vaginosis vs trich on a slide. I’m surprised that of all things, this was left out.

Im also curious to know what other things we learn. Unless we’re just putskying around like they say, taking our time and relaxing while studying for step one, when we could just learn it all in half the time!

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I know there are endless “PA vs MD/DO curriculum” threads out there, but this is something I’ve never figured out

Do PAs just skip anything related to a microscope? Can PAs read peripheral smears? I was studying with a PA friend and she looked at my computer, and I had a picture of a lymph node biopsy with Hodgkin’s lymphoma and she said “ew why do you even have to know that”. She’s a first year PA student so she said she didn’t learn this yet but I’m kind of wondering if she ever will? But I didn’t wanna be a jerk and ask. But fr if i showed a PA a peripheral smear would they be able to point out an eosinophil? I if I showed a light microscopy image of PSGN would they be able to tell that it’s a glomerulus?

They always say they learn everything we learn in 1/2 the time but I feel like not knowing what blood or lymphoma or a Pap smear looks like is kind of... odd...

Imagine doing a Pap smear but having no idea what a koilocyte looks like. Even in primary care, not being able to distinguish bacterial vaginosis vs trich on a slide. I’m surprised that of all things, this was left out.

Im also curious to know what other things we learn. Unless we’re just putskying around like they say, taking our time and relaxing while studying for step one, when we could just learn it all in half the time!
Wow lol just noticed that I am incapable of writing a title and the name of this whole thing doesn’t even make sense. My bad. Let the roast commence.
 
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I know there are endless “PA vs MD/DO curriculum” threads out there, but this is something I’ve never figured out

Do PAs just skip anything related to a microscope? Can PAs read peripheral smears? I was studying with a PA friend and she looked at my computer, and I had a picture of a lymph node biopsy with Hodgkin’s lymphoma and she said “ew why do you even have to know that”. She’s a first year PA student so she said she didn’t learn this yet but I’m kind of wondering if she ever will? But I didn’t wanna be a jerk and ask. But fr if i showed a PA a peripheral smear would they be able to point out an eosinophil? I if I showed a light microscopy image of PSGN would they be able to tell that it’s a glomerulus?

They always say they learn everything we learn in 1/2 the time but I feel like not knowing what blood or lymphoma or a Pap smear looks like is kind of... odd...

Imagine doing a Pap smear but having no idea what a koilocyte looks like. Even in primary care, not being able to distinguish bacterial vaginosis vs trich on a slide. I’m surprised that of all things, this was left out.

Im also curious to know what other things we learn. Unless we’re just putskying around like they say, taking our time and relaxing while studying for step one, when we could just learn it all in half the time!


Wow bro. Of all things to give a **** about.
 
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Out of all the things they don’t learn that affects patient care, this is something I care absolutely nothing about. The last time I read a peripheral smear slide was for step 1.
 
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I know there are endless “PA vs MD/DO curriculum” threads out there, but this is something I’ve never figured out

Do PAs just skip anything related to a microscope? Can PAs read peripheral smears? I was studying with a PA friend and she looked at my computer, and I had a picture of a lymph node biopsy with Hodgkin’s lymphoma and she said “ew why do you even have to know that”. She’s a first year PA student so she said she didn’t learn this yet but I’m kind of wondering if she ever will? But I didn’t wanna be a jerk and ask. But fr if i showed a PA a peripheral smear would they be able to point out an eosinophil? I if I showed a light microscopy image of PSGN would they be able to tell that it’s a glomerulus?

They always say they learn everything we learn in 1/2 the time but I feel like not knowing what blood or lymphoma or a Pap smear looks like is kind of... odd...

Imagine doing a Pap smear but having no idea what a koilocyte looks like. Even in primary care, not being able to distinguish bacterial vaginosis vs trich on a slide. I’m surprised that of all things, this was left out.

Im also curious to know what other things we learn. Unless we’re just putskying around like they say, taking our time and relaxing while studying for step one, when we could just learn it all in half the time!
MD/DOs aren't taught to read peripheral smear slides. We're taught to recognize pathognomonic signs like Auer rods in A(P)ML, Hodgkin's Lymphoma, etc. if they're put right in front of us often supplemented with a clinical vignette that's also pointing towards the diagnosis. Yes, the histology curriculum may cover eosinophlic staining patterns and such reasoning but you're never simply asked to look at a histology slide and make a broad inference for USMLE or even any aspects of medical training unless you're doing a pathology elective in 4th year where you'll dive deeper into histology. Maybe some did it in their curriculum but it's not core content for physicians in the US to know. That is for Pathology residents.
 
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MD/DOs aren't taught to read peripheral smear slides. We're taught to recognize pathognomonic signs like Auer rods in A(P)ML, Hodgkin's Lymphoma, etc. if they're put right in front of us often supplemented with a clinical vignette that's also pointing towards the diagnosis. Yes, the histology curriculum may cover eosinophlic staining patterns and such reasoning but you're never simply asked to look at a histology slide and make a broad inference for USMLE or even any aspects of medical training unless you're doing a pathology elective in 4th year where you'll dive deeper into histology. Maybe some did it in their curriculum but it's not core content for physicians in the US to know. That is for Pathology residents.

In our path lab, for each case someone would get picked to drive the scope on an unlabeled slide and would have to describe what they see and everything. It was challenging but fun.
 
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I think we need a midlevel master thread rather than cluttering the forums with every single thing to bash midlevels on (while doing literally nothing actionable to solve the underlying problems)
 
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I know there are endless “PA vs MD/DO curriculum” threads out there, but this is something I’ve never figured out

Do PAs just skip anything related to a microscope? Can PAs read peripheral smears? I was studying with a PA friend and she looked at my computer, and I had a picture of a lymph node biopsy with Hodgkin’s lymphoma and she said “ew why do you even have to know that”. She’s a first year PA student so she said she didn’t learn this yet but I’m kind of wondering if she ever will? But I didn’t wanna be a jerk and ask. But fr if i showed a PA a peripheral smear would they be able to point out an eosinophil? I if I showed a light microscopy image of PSGN would they be able to tell that it’s a glomerulus?

They always say they learn everything we learn in 1/2 the time but I feel like not knowing what blood or lymphoma or a Pap smear looks like is kind of... odd...

Imagine doing a Pap smear but having no idea what a koilocyte looks like. Even in primary care, not being able to distinguish bacterial vaginosis vs trich on a slide. I’m surprised that of all things, this was left out.

Im also curious to know what other things we learn. Unless we’re just putskying around like they say, taking our time and relaxing while studying for step one, when we could just learn it all in half the time!

yes PA do skip the microscope. all MD's except for pathologists should also. you found the worst thing to complain about.
 
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As many of us will be hiring PAs/NPs to supplement our work force, I think it’s important to have open dialogue about their training as it compares to ours. I spoke at length with a PA student who worked along side me in clinic while on my M3 rotations, and it sounded like they learn “the same thing in half the time” because they skip a lot of physiology/pharm details, and their pathology content was about half. This guy I was talking to had never heard of Wegners Granulomatosis, for example.
 
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As many of us will be hiring PAs/NPs to supplement our work force, I think it’s important to have open dialogue about their training as it compares to ours. I spoke at length with a PA student who worked along side me in clinic while on my M3 rotations, and it sounded like they learn “the same thing in half the time” because they skip a lot of physiology/pharm details, and their pathology content was about half. This guy I was talking to had never heard of Wegners Granulomatosis, for example.
That's a problem with PA curriculum. What if you give PA students Pathoma + B&B + UWorld + Sketchy for first 2 years of their preclinical education? Will they be comparable with med students in science knowledge?
 
That's a problem with PA curriculum. What if you give PA students Pathoma + B&B + UWorld + Sketchy for first 2 years of their preclinical education? Will they be comparable with med students in science knowledge?

Well they don’t do 2 years of preclinical education. Their school is only about 2.5 years long. But yeah, if you gave a PA student with a solid performance historically in science classes all the same resources we use and then tell them to study them for 1.5 years, they would likely have a comparable basic science knowledge. Would they be able to apply that knowledge clinically? Probably not since they don’t really learn that. But regardless, that isn’t what happens at PA school. If it was, it would be called medical school.
 
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As many of us will be hiring PAs/NPs to supplement our work force, I think it’s important to have open dialogue about their training as it compares to ours. I spoke at length with a PA student who worked along side me in clinic while on my M3 rotations, and it sounded like they learn “the same thing in half the time” because they skip a lot of physiology/pharm details, and their pathology content was about half. This guy I was talking to had never heard of Wegners Granulomatosis, for example.


I have a similar story as your example. Solo NP in rural area did 2 rounds of system steroids and 1 round of abx for vertigo symptoms for an ear infection. I was on an ent rotation. They referred to us. The lady started telling the story and it was classic BPPV. I mean a literal vignette. It just goes to show you that you don’t know what you don’t know. If they aren’t exposed to it then how can the diagnosis be on their differential
 
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I have a similar story as your example. Solo NP in rural area did 2 rounds of system steroids and 1 round of abx for vertigo symptoms for an ear infection. I was on an ent rotation. They referred to us. The lady started telling the story and it was classic BPPV. I mean a literal vignette. It just goes to show you that you don’t know what you don’t know. If they aren’t exposed to it then how can the diagnosis be on their differential

Wish that was unusual. I’m on psych right now and a psych NP around here constantly introduces herself as Dr. to everyone including the psychiatrists and patients. She refers patients for the stupidest reasons and like every patient that comes from her is on a ridiculously inappropriate pharm regimen.
 
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That's a problem with PA curriculum. What if you give PA students Pathoma + B&B + UWorld + Sketchy for first 2 years of their preclinical education? Will they be comparable with med students in science knowledge?

I think this is a good question I have thought about alot. In short yes, they will come out with the same education. There are other factors which differentiate.

Last time I checked, acceptance into medical school was hard. There's a critical thinking test called the MCAT. We will be able to apply the knowledge and interpret things more efficiently. In short, we are more fundamentally sound.

I think the same principle needs to apply to basic science education. Forget the breadth of medical knowledge and let's get some depth. Let's teach medical students how imaging works and how to correlates images clinically. Don't tell me that's only for Radiologists. As physicians whether we're interested in Gen Surg, GI, or Heme/Onc we should be able to interpret imaging. I don't care if students never learn about the outdated Schilling's Test or the various vasculitides. Let's focus on when it's appropriate to order an ANA on a patient and what results mean. This should be done in didactic form so we are all on the same page.

We can have one year dedicated to all this "stuff we will never see again" material so we at least know it exists and how to look it up for reference. Then, M2 needs to be a clinical didactics/rotation hybrid. This is how we get PAs/NPs out. We focus on fundamentals, not delay our progression to clinical medicine as a tribute to advanced pathology we've never seen in a 100 years so we can brag to our NP/PA colleagues how we know what vitamin deficiency induced CM looks like. There are actually a lot of foundational concepts that are useful that need to be taught alongside clinical medicine. Why do they need to be recalled from M1/2 year as residents/fellows?
 
I think this is a good question I have thought about alot. In short yes, they will come out with the same education. There are other factors which differentiate.

Last time I checked, acceptance into medical school was hard. There's a critical thinking test called the MCAT. We will be able to apply the knowledge and interpret things more efficiently. In short, we are more fundamentally sound.

I think the same principle needs to apply to basic science education. Forget the breadth of medical knowledge and let's get some depth. Let's teach medical students how imaging works and how to correlates images clinically. Don't tell me that's only for Radiologists. As physicians whether we're interested in Gen Surg, GI, or Heme/Onc we should be able to interpret imaging. I don't care if students never learn about the outdated Schilling's Test or the various vasculitides. Let's focus on when it's appropriate to order an ANA on a patient and what results mean. This should be done in didactic form so we are all on the same page.

We can have one year dedicated to all this "stuff we will never see again" material so we at least know it exists and how to look it up for reference. Then, M2 needs to be a clinical didactics/rotation hybrid. This is how we get PAs/NPs out. We focus on fundamentals, not delay our progression to clinical medicine as a tribute to advanced pathology we've never seen in a 100 years so we can brag to our NP/PA colleagues how we know what vitamin deficiency induced CM looks like. There are actually a lot of foundational concepts that are useful that need to be taught alongside clinical medicine. Why do they need to be recalled from M1/2 year as residents/fellows?
Ehh the MCAT is overrated because the AAMC clearly specified 500+ is passing for medical boards. The critical thinking doesn't really kick in until at least 90th percentile level

I agree with much of your proposal and i think exams should be even more geared towards higher levels of thinking and resistant to memorizing. Because frankly, with how memorizing and algorithm heavy med education is, we need the critical thinking and analytical skills to really distinguish us
 
Ehh the MCAT is overrated because the AAMC clearly specified 500+ is passing for medical boards. The critical thinking doesn't really kick in until at least 90th percentile level

I agree with much of your proposal and i think exams should be even more geared towards higher levels of thinking and resistant to memorizing. Because frankly, with how memorizing and algorithm heavy med education is, we need the critical thinking and analytical skills to really distinguish us
The science portions test chart/data interpretation, logic, and verbal reasoning skills in addition to content areas. The MCAT may or may not be overrated. A study was done to show it 500 correlated with board pass rate, but I don't know if studies were done to look at MCAT and other metrics of a good medical student (which are what exactly? - where they end up? that's self selection). As for the 90th percentile guestimate, I would say there's many reasons people get things wrong on the MCAT including knowledge gaps, lack of interpretation skills, etc. It's not like most people are getting the knowledge stuff right and the upper tenth is separated based on reasoning skills.

I agree with your point about how medical education needs to incorporate more critical thinking/analytical skills. We need to be analyzing research together as it comes out as a daily exercise. The public views us as authorities on things related to medicine so let's be that...not just people memorizing exergonic/rate limiting steps of the Krebs Cycle. If someone asks me about what the data on the CDC lifting the mask requirements, I should be able to give an informed answer and be able to critiquely evaluate that data. This should be taught in medical school.
 
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The science portions test chart/data interpretation, logic, and verbal reasoning skills in addition to content areas. The MCAT may or may not be overrated. A study was done to show it 500 correlated with board pass rate, but I don't know if studies were done to look at MCAT and other metrics of a good medical student (which are what exactly? - where they end up? that's self selection). As for the 90th percentile guestimate, I would say there's many reasons people get things wrong on the MCAT including knowledge gaps, lack of interpretation skills, etc. It's not like most people are getting the knowledge stuff right and the upper tenth is separated based on reasoning skills.

I agree with your point about how medical education needs to incorporate more critical thinking/analytical skills. We need to be analyzing research together as it comes out as a daily exercise. The public views us as authorities on things related to medicine so let's be that...not just people memorizing exergonic/rate limiting steps of the Krebs Cycle. If someone asks me about what the data on the CDC lifting the mask requirements, I should be able to give an informed answer and be able to critiquely evaluate that data. This should be taught in medical school.

Agreed. We had about 6 sessions on analyzing papers and interpreting the stats. It was surprising how many people in med school don’t know how to appraise the quality of a study and what it means.
 
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Agreed. We had about 6 sessions on analyzing papers and interpreting the stats. It was surprising how many people in med school don’t know how to appraise the quality of a study and what it means.

Vinay Prasad had a great bit on this - more of his students knew what an Aschoff body was than could explain what P-values mean
 
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As many of us will be hiring PAs/NPs to supplement our work force, I think it’s important to have open dialogue about their training as it compares to ours. I spoke at length with a PA student who worked along side me in clinic while on my M3 rotations, and it sounded like they learn “the same thing in half the time” because they skip a lot of physiology/pharm details, and their pathology content was about half. This guy I was talking to had never heard of Wegners Granulomatosis, for example.

But I mean, had she heard of vasculitis? Because Wegner's is pretty rare and many doctors have never (a) seen a case or (b) remember what it is past Step 1/med school. I think making these types of arguments, like the OP, diminish the real arguments about their knowledge base.


Wish that was unusual. I’m on psych right now and a psych NP around here constantly introduces herself as Dr. to everyone including the psychiatrists and patients. She refers patients for the stupidest reasons and like every patient that comes from her is on a ridiculously inappropriate pharm regimen.

Is she actually a DNP or just an NP? And even if just a DNP, is this allowed in your hospital/state? Because if not, I'd report her to the licensing board. So inappropriate.
 
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But I mean, had she heard of vasculitis? Because Wegner's is pretty rare and many doctors have never (a) seen a case or (b) remember what it is past Step 1/med school. I think making these types of arguments, like the OP, diminish the real arguments about their knowledge base.




Is she actually a DNP or just an NP? And even if just a DNP, is this allowed in your hospital/state? Because if not, I'd report her to the licensing board. So inappropriate.

She has a PhD in nursing. I don’t think it is allowed at my facility. I have to look.
 
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I’m am a teaching hospitalist and the affiliated school has all sorts of programs. So some of the floor nurses are also in school for NP. I’ve befriended many.

Every single one that I have later encountered tells me that they are ill -prepared and that the responsibility feels like an enormous burden. Only then do they ask me, “How do you do it?!”
 
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... that is tragic
Vinay Prasad had a great bit on this - more of his students knew what an Aschoff body was than could explain what P-values mean
Yeah but was there a >5% chance that his observation (or an observation more extreme) could have been observed even if more students in fact knew what a P-value was?
 
Yeah but was there a >5% chance that his observation (or an observation more extreme) could have been observed even if more students in fact knew what a P-value was?

n=1 but wut?
 
I don’t care if they can’t tell a platelet from a neutrophil. There’s bigger fish to fry.

There’s too many that can’t tell scabies from psoriasis.
 
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I don't think PA's learn much (if any) microscopy. Pathologists and hematologist/oncologists are experts at peripheral smears, and some community-based primary care docs read them pretty well.
 
I have no idea what a koilocyte is, let alone what it looks like on a Pap smear.

I vaguely remember something about clue cells (maybe?) in differentiating GU infections but I suspect that an experienced primary care PA would be much more adept than I am at reading a wet mount slide.

If you're a preclinical med student you could probably stump me on well over 50% of your pathology slides, and I had a high Step 1 score. I don't think this is the midlevel hill to die on.
 
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But I mean, had she heard of vasculitis? Because Wegner's is pretty rare and many doctors have never (a) seen a case or (b) remember what it is past Step 1/med school. I think making these types of arguments, like the OP, diminish the real arguments about their knowledge base.

This. Medical education needs to stop worrying about covering every pathology and having students create flashcards to memorize obscure details of rare pathology and focus on:

1.) Appraisal of medical literature - a separate test for licensure, I don't like how drug ads Qs are mixed in with clinical content/vignettes about disease. It makes it too much about test-taking strategy.
2.) Competence in the hospital: What is this line in the patient's body? Why does it cause infection moreso than this line in the patient's body? How much does this line cost? It requires some didactic training. All you purists can say this is what residency's for and people learn on the job, but then how do we know all students know this. Are we going to rely on subjective faculty evaluations of residents...? Because that's what we are doing now.
3.) Basic Science to Clinical Science: This is the physics of a lung. Now let's immediately (without waiting 3 years) learn how this applies to ventilator.

This is how we differentiate ourselves from midlevels. We already put students on that path with the liberal arts/science background in high school and college. Then...for some obscure reason we say...hey, forget all that. Now let's just teach you to memorize this giant amount of information so that we can say you know what Wegener's Granulomatosis is and that will be what differentiates physicians from PAs/NPs har har har...

I think we've taken the right steps by P/F'ing Step 1. Step 2 CK is no great test either though and there's still a lot left to be desired. Unless we add these components student's priorities will shift towards pumping out &*^% publications and networking.

The thing is I can't just start my own medical school. If I implemented all the changes I rant about on SDN, they don't have the value in the residency market yet. Other medical schools need to do it and to their credit, some are.
 
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I know there are endless “PA vs MD/DO curriculum” threads out there, but this is something I’ve never figured out

Do PAs just skip anything related to a microscope? Can PAs read peripheral smears? I was studying with a PA friend and she looked at my computer, and I had a picture of a lymph node biopsy with Hodgkin’s lymphoma and she said “ew why do you even have to know that”. She’s a first year PA student so she said she didn’t learn this yet but I’m kind of wondering if she ever will? But I didn’t wanna be a jerk and ask. But fr if i showed a PA a peripheral smear would they be able to point out an eosinophil? I if I showed a light microscopy image of PSGN would they be able to tell that it’s a glomerulus?

They always say they learn everything we learn in 1/2 the time but I feel like not knowing what blood or lymphoma or a Pap smear looks like is kind of... odd...

Imagine doing a Pap smear but having no idea what a koilocyte looks like. Even in primary care, not being able to distinguish bacterial vaginosis vs trich on a slide. I’m surprised that of all things, this was left out.

Im also curious to know what other things we learn. Unless we’re just putskying around like they say, taking our time and relaxing while studying for step one, when we could just learn it all in half the time!
I was a PA before returning to medical school. I can unequivocally state that PAs don't do any significant histopathology in class. Certainly not enough to even come close to being able to read smears. Nowhere near enough to have a hope in hell of doing well on Step/Level 1.
And no..they don't come close to learning the same material in half the time.....what they learn is very broad but superficial and skips histology and embryology altogether. A good PA student should be able to identify an eosinophil on a slide....but those are pretty much the easiest WBC to grossly identify on an H&E stain...very few, if any, PA students would be able to identify a glomerulus on a slide unless they were exposed to histology as undergraduates.

Now in PA school we did learn about clue cells and Trich in didactics, saw slides. During my OBGYN rotation, in gyn clinic the residents had a few microscopes and did their own wet mounts, KOH preps. I had to do pelvics and paps and did wet mounts/KOH preps too...I was treated the same as MS-3s were. I got pretty comfortable and when I worked in primary care actually discussed getting a microscope with my SP...which we did. It was billable ancillary income and it was convenient for the patient to get a point-of-care diagnosis rather than waiting on lab results.

As for recognizing histopathology....unless you're a pathologist or go into hemeonc, or Moh's surgery, that is something med students really only need to know for Step/Level 1. So I wouldn't harp too much about PA students not getting histology in school.....it's just not something that is needed for their job proficiency.

There is a separate midlevel entity called a Pathology Assistant.....they do work exclusively in pathology labs under a pathologist. The program is Master's level. A friend of mine is a pathology assistant. They do get histology education.
 
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As many of us will be hiring PAs/NPs to supplement our work force, I think it’s important to have open dialogue about their training as it compares to ours. I spoke at length with a PA student who worked along side me in clinic while on my M3 rotations, and it sounded like they learn “the same thing in half the time” because they skip a lot of physiology/pharm details, and their pathology content was about half. This guy I was talking to had never heard of Wegners Granulomatosis, for example.
Can confirm: In PA pathophysiology and systems courses, the lectures were so broad and superficial that the lecturer might drop the work Wegener's granulomatosis but it was not something that was tested. I do recall the professor (pathologist) using the word small round blue cell tumors and not really going into what it meant. It was never something any PA certification or recertification exam ever tested.
Those terms were something I had to read about after graduation when I'd encounter them in clinical practice....often when I'd read a consult letter. I made a list of **** each day I'd never heard of and read up on it when I'd get home.
 
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But I mean, had she heard of vasculitis? Because Wegner's is pretty rare and many doctors have never (a) seen a case or (b) remember what it is past Step 1/med school. I think making these types of arguments, like the OP, diminish the real arguments about their knowledge base.

We had a patient with a possible GPA. The residents and attendings forgot which ANCA was associated with which when we were putting in orders for a work up. I mean they could have just looked it up, but being the third year med student, I just told them since I had to know that **** not too long ago. What I’m saying is that I think as long as you know in general that there are things like GPA and generally what they might present with, you’re fine. But I don’t know if midlevels even know that.
 
But I mean, had she heard of vasculitis? Because Wegner's is pretty rare and many doctors have never (a) seen a case or (b) remember what it is past Step 1/med school. I think making these types of arguments, like the OP, diminish the real arguments about their knowledge base.




Is she actually a DNP or just an NP? And even if just a DNP, is this allowed in your hospital/state? Because if not, I'd report her to the licensing board. So inappropriate.
Completely disagree. A primary doc might not remember all of the details of Wegner’s, but when a patient comes in with hematuria and chronic sinusitis, they will recall that a certain vasculitis may present similarity. They can easily look up the proper diagnostic tests and get the patient to the right specialist. A PA would miss the diagnosis completely.
 
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Completely disagree. A primary doc might not remember all of the details of Wegner’s, but when a patient comes in with hematuria and chronic sinusitis, they will recall that a certain vasculitis may present similarity. They can easily look up the proper diagnostic tests and get the patient to the right specialist. A PA would miss the diagnosis completely.

I think the benefit of the doctor is knowing that sometimes things link together even if they don’t remember the disease exactly. I’d be more concerned that the midlevel doesn’t see the connection or even see it as a vasculitis. Leading to them thinking it’s recurrent bacterial sinusitis and bacterial pyelonephritis and prescribing multiple rounds of antibiotics without improvement. Not having a depth of a ddx really leaves them handicapped. Everything has to be a common presentation of the common thing.
 
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Completely disagree. A primary doc might not remember all of the details of Wegner’s, but when a patient comes in with hematuria and chronic sinusitis, they will recall that a certain vasculitis may present similarity. They can easily look up the proper diagnostic tests and get the patient to the right specialist. A PA would miss the diagnosis completely.

I'm not going to get dragged into a debate about PA versus MD. That's missing the point. What I'm saying is that arguing about this is the same as some guy who's house was just destroyed in a fire arguing with his son because the son ran up the electric bill the week before.
 
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Completely disagree. A primary doc might not remember all of the details of Wegner’s, but when a patient comes in with hematuria and chronic sinusitis, they will recall that a certain vasculitis may present similarity. They can easily look up the proper diagnostic tests and get the patient to the right specialist. A PA would miss the diagnosis completely.
If a patient comes in with hematuria, that's going to set off alarm bells hopefully to any caregiver unless the patient is completely healthy and just ran a marathon. Not many PCPs are diagnosing Wegener's based off of non-specific findings or going through the whole differential process in the real world with all the stuff that gets put on their plate. If the case of non-specific findings that don't get better (fever/malaise), PAs would also know indolent infection and autoimmune items are in the ddx.

I think the bigger thing we have going for us is that overall we're more detail oriented, thorough, and possess better reasoning skills. It's what got us into medical school in the first place.
 
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I think the bigger thing we have going for us is that overall we're more detail oriented, thorough, and possess better reasoning skills. It's what got us into medical school in the first place.

I also think that the NP/PA curriculum is geared up towards an if/then algorithmic process. As in, a primary care midlevel would likely see someone who was diagnosed with pulmonary hypertension and start sildenafil because “it’s a pulmonary HTN med.” Most would have no idea that a right heart cath and WHO group classification is what determines appropriate treatment


if you have an NP who works specifically with a pulmonology group then they will know about a right heart cath and may be able to tell you clinical pearls like “the number one cause of right heart failure is left heart failure” because they picked it up while working with their group. And a resident only learns it if they pick it up on their pulm or inpatient rotations.

A mentor once told me that being a good midlevel is like being a resident, forever. You always have some degree of supervision and you’re always learning. It’s when you remove this supervision and learning and give new grads independence that it becomes alarming.

My final thought is that wisdom is knowing what you don’t know. A med student knows that they know nothing when they graduate. A resident knows that practicing independently is terrifying and that it’s impossible to know everything. I’m not sure a midlevel has an adequate impression of what they don’t know.
 
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Ok my actual final thought vis a vis the original topic is “Who cares if they don’t know the pathology. Not knowing the pathophysiology is worse.”
 
And a resident only learns it if they pick it up on their pulm or inpatient rotations.

What? That is an extremely basic concept, and we learned that like the first day of cardio/pulm/renal in M1. There are definitely things you’ll only pick up on rotations and as a resident, but that isn’t one of them.
 
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What? That is an extremely basic concept, and we learned that like the first day of cardio/pulm/renal in M1. There are definitely things you’ll only pick up on rotations and as a resident, but that isn’t one of them.
Your students must be better than mine because mine only have a vague concept of pulmonary HTN is. My residents know it a little bit better but I still have to teach it to them.
 
Well since we are on this topic, PAs are working on becoming independent. If I heard correctly, there is one state where this has happened. This is very very disturbing.
 
Your students must be better than mine because mine only have a vague concept of pulmonary HTN is. My residents know it a little bit better but I still have to teach it to them.

Oh I don’t know if we all remember the nitty gritty details, but we definitely had to know that stuff in med school. It’s kind of disturbing to think there are med students graduating who barely know that right heart failure is most commonly caused by left heart failure. It’s one thing to say that students are graduating forgetting what some rando rare disease is.
 
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Well since we are on this topic, PAs are working on becoming independent. If I heard correctly, there is one state where this has happened. This is very very disturbing.
Yep....meanwhile NPs already have independence in like half the country and they've got bills under deliberation in most of the rest.
 
kind of disturbing to think there are med students graduating who barely know that right heart failure is most commonly caused by left heart failure.

Oh no, that’s my fault for being unclear. If I say “the most common cause of right heart failure is....” then there will be a chorus of “left heart failure.” But if I just ask them to tell me about what pulmonary hypertension is, and dx and pathology and Tx, they don’t know where to begin. That’s my job to teach them that during Med school or residency. But a PA will likely not learn that during school and probably not in practice unless they specifically work for a pulmonary group.
 
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Oh no, that’s my fault for being unclear. If I say “the most common cause of right heart failure is....” then there will be a chorus of “left heart failure.” But if I just ask them to tell me about what pulmonary hypertension is, and dx and pathology and Tx, they don’t know where to begin. That’s my job to teach them that during Med school or residency. But a PA will likely not learn that during school and probably not in practice unless they specifically work for a pulmonary group.

Oh okay. Yes I was misunderstanding you.
 
Maybe I am just paranoid but this post screams troll to me. The only other explanation is someone who has almost zero exposure to clinical medicine and never talks to their MD classmates. I mean come on...histology??? Histology is meme level low-yield at every medical school and med students complain how useless it is from day one of M1.
 
Yep....meanwhile NPs already have independence in like half the country and they've got bills under deliberation in most of the rest.
Yeah, NPs are independent in my state. I think most do not practice independently. Many of them work for doctors in private practice.
 
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