Forensic path elective coming up, help me shine

[DD214_DOC]

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Hey guys,

I have never really considered seriously the idea of doing pathology. The more of medicine I experience, the more I realized most fields have nothing to do with solving puzzles or, "figuring things out". I think I will really like pathology.

My question is, how do I shine on a fourth-year forensic path elective? What books should I read up on beforehand, to get a good foundation for what I will be doing? I know it won't be all law-enforcement related autopsies and that there will be plenty of slide looking.

I'm Army too, so I don't really know how different the Army match for path is. Below average COMLEX I score.

I really want to do well in the anticipation that I will really like path. Thanks.

 

[tardieu]

If you like solving puzzles, figuring things out, incorporating a broad range of information, including nonmedical information, working with people from diverse fields, communicating your findings to people with all manner of backgrounds, and, yes, talking with families on a regular basis, forensic pathology is for you.

As far as “shining” during your rotation, keep in mind that most FPs and pathologists in general are less high strung than most of our clinical colleagues. Enthusiasm and demonstrated interest will be appreciated, but if it starts getting too gunner it may backfire.

If you want to set yourself apart, here are a few suggestions:

1. Read up on basic things: Postmortem changes, causes of sudden natural death, the difference between laceration and incised wound (everyone gets that wrong), how to distinguish antemortem from postmortem blood clots, why some cases are accepted by the ME and why other cases are denied, things like that.

2. Acquaint yourself as thoroughly as possible with the principles and practice of death certification. This will help you no matter what area of medicine you end up in. What’s the difference between mechanism of death and immediate, intermediate and underlying causes of death? What’s manner of death all about? Why is it important? There’s a good tutorial at www.thename.org. The book by Dolinak is also good, for this and other topics. It has lots of pictures.

3. Learn the differences between a coroner system and a medical examiner system. Do not confuse the latter with the former. You may insult someone.

These things may sound boring and pedestrian, but it’s very common for rotators to be fixated on the sensational things like gunshots, extreme trauma, etc. If you demonstrate an interest in and familiarity with the basics that will set you apart.

 

[Gut Shot]

My question is, how do I shine on a fourth-year forensic path elective? What books should I read up on beforehand, to get a good foundation for what I will be doing?

Go to the library and get a copy of "Forensic Pathology: Principles and Practice" by Dolinak et al. Reading it cover to cover is unnecessary. You can skim the case studies, examine the photos and diagrams, etc., and you will quickly find yourself up to speed on the high points.

If that isn't available, there are any number of solid textbooks out there. Spitz and Fisher is a classic.

As for shining, if you are earnest then it won't be hard. Show up early, show some enthusiasm, see as much as you possibly can, and do not be afraid to get your hands dirty (if they let you). Go to crime scenes, watch some courtroom testimony, tour the tox and ballistics labs... basically do everything you have the option of doing.

 

[DD214_DOC]

Thanks, I really appreciate it. As far as the not being high strung, that is absolutely nothing to worry about as I am the same exact way. I tend to keep to myself, have a low energy level, and find most people annoying, especially high strung people.

It sounds like FP may actually be what I think it is. So far I've been really disappointed with medicine in general as I don't feel like I'm solving or figuring out anything. I'm just recognizing a pattern that has already been established by someone else, giving it a name, and then following steps that have already been predetermined. Blah.

 

[BWSTW]

What areas would I need to do well in to get a residency in path?

 

[SLUsagar]

My question is, how do I shine on a fourth-year forensic path elective? What books should I read up on beforehand, to get a good foundation for what I will be doing? I know it won't be all law-enforcement related autopsies and that there will be plenty of slide looking.

I really want to do well in the anticipation that I will really like path. Thanks.

just an FYI though -- if you're considering a career in path, i'd recommend getting more exposure to day-to-day "typical" (if you will) events for most pathologists...that is surgical pathology (would also recommend getting some exposure to CP, clinical pathology). If you're judging PATH as a career just by your exposure to forensics, you could seriously jeopardize your opinion of our beloved field.

 

[HbyHA]

tardieu gives excellent advice. and don't forget most cases that get referred to the ME's office are actually natural deaths. its not all GSWs and CSI (don't get me started...)

SLUsugar also gives good advice. don't confuse forensic pathology with the general practice of pathology. it's not. if you think pathology may be for you, spend some time in the hospital's path dept doing AP. also see CP. if you decide to do pathology, you'll be doing a general AP (or AP/CP) residency for 3 (or 4 years). of that, only a few months (or a few weeks!) will be spent doing FP. that's a loooooong time to do something you're not that thrilled with. trust me. i've spent the last 7 years of my life (med school + residency) just waiting to get to my fellowship (i knew i was doing FP the day i walked into med school). during that time, i've done 11 weeks of FP. thats it!

 

[Autopsy101]

My advice would be to try and come in on weekends if possible. People might think that you are trying to be a gunner, but my experience has been that most of the good cases (homicides, weird suicides, or interesting traffics and accidents) happen on weekends when people have more time to engage in dangerous behavior like drugs and alcohol to impair judgement. I came in all the weekends during my rotations, and I was really glad that I did.

 

[Adrian Cocot]

Find the appropriate time and yell "PWNED!" After that it's smooth sailing.

 

[DD214_DOC]

So, after some more thinking I really don't think I will end up in pathology. I think forensic path is cool, but I'm 99% sure I'm not going to like the, "other stuff". I seem, for some reason, to need patient contact, even though most people are idiots and a pain to deal with.

Having said that, how should I approach this rotation on day one knowing that I'm doing it just because i think it would be cool and interesting, not because I actually care that much about entering the field. (at least for now, I did leave a 1% chance of liking the other stuff)

 

[HbyHA]

Day 1:
- Don't pass out, vomit, or complain about smells
- Don't refer to decedents as "cadavers", it's depersonalizing
- Don't be a wallflower, get involved as much as you are allowed to be
- Don't expect to be constantly entertained with cool CSI-like cases

Day 2 through 30: Repeat!

 

[BlondeDocteur]

bumpity bump...

I am incredibly excited that my last month of medical school will be spent at the NYC Medical Examiner's office. I am generally an active, curious person who does not mind long hours and I hope to get the most out of it.

Our library doesn't have the Dolinak text (all we have of his oeuvre is a medicolegal neuropath atlas), and the most recent edition of Werner & Spitz we have is from 1980. Which of the other basic forensic path texts would you recommend?

(The selection:
http://cliobeta.cul.columbia.edu:70...d=38584&recPointer=0&recCount=10&searchType=7

And lastly, what is the realistic scope of my involvement at scenes of death or medicolegal autopsies?

 

[Parts Unknown]

and the most recent edition of Werner & Spitz we have is from 1980.

I was raised on that edition, and it will serve you just fine. Most of your forensic cases will be suicides, ODs, accidents and homicides, and not much has changed in the realm of strangulation, shootings, stabbings, blunt force trauma, etc. The images in W&S have been reused ad infinitum even to this day. Some of the more esoteric stuff like airplane crash site investigation is unlikely to help you.

A pre-Roe v. Wade edition before 1980 has a chapter on scene investigation for illegal abortion clinics. Good times.

 

[HbyHA]

i will be doing my fellowship there starting in July, and i rotated there as a resident in 08. i loved it!

there will be no long hours for you guys. those of us auditioning for the fellowship were there at 7:30 am. The non-interested residents and med students strolled in closer to 8:30. we all left after the 2:00 conference (3:00 on certain days).

Fisher and Spitz is way too in depth for your needs, but if it's all you have, try reading the introductory chapters and looking at the pictures.

most of the cases i saw during my month there were naturals. some suicides and accidents. two homicides, that's it. things can come in waves, but it's much more civilized in Manhattan these days😀 they send us to the other boroughs to catch our homicides.

i suspect the scope of your involvement will be primarily observational. scene investigation is the responsibility of the medico-legal investigators, who hand the ME's the report. sometimes we looked at the photographs they took at the scene if we felt it was necessary. i doubt students get to come along to scenes. back at the morgue, there's usually an army of residents rotating through during any given month, since it's a requirement for AP training and there are quite a few path residencies in NYC. they sometimes cut the organs (depending on the ME assigned to the case). many of us need to use some forensic cases to make our required 50.

that doesn't mean you can't learn a lot by looking and asking questions. and feel some organs, too! if you're really lucky, you'll get to squish through some week-old decomp brain looking for bullet fragments (ah, the memories!)

have fun!

 

[BlondeDocteur]

Thanks, HbyHA. The description of the student elective specifically states that we are to be present at scenes of death and "assist" with medicolegal autopsies, as well as tag along to court. I was hoping it was one of those "show enough interest and your scope will be widened" things.

As a PGY-0 in surgery is there any chance of putting everything back in and sewing it up? Or is that the realm of the autopsy assistant?

 

[HbyHA]

Thanks, HbyHA. The description of the student elective specifically states that we are to be present at scenes of death and "assist" with medicolegal autopsies, as well as tag along to court. I was hoping it was one of those "show enough interest and your scope will be widened" things.

As a PGY-0 in surgery is there any chance of putting everything back in and sewing it up? Or is that the realm of the autopsy assistant?

i would still encourage you to ask about doing going to scenes and court with the realistic expectation that it may not happen.

as far as putting everything back in goes, we just toss the pieces in a trash bag and put it in the body. nothing glamorous there. and the autopsy assistants take care of sewing the body up, but i suppose you could always ask to help out.

 

[Ruination]

bumpity bump...

I am incredibly excited that my last month of medical school will be spent at the NYC Medical Examiner's office. I am generally an active, curious person who does not mind long hours and I hope to get the most out of it.

Our library doesn't have the Dolinak text (all we have of his oeuvre is a medicolegal neuropath atlas), and the most recent edition of Werner & Spitz we have is from 1980. Which of the other basic forensic path texts would you recommend?

(The selection:
http://cliobeta.cul.columbia.edu:70...d=38584&recPointer=0&recCount=10&searchType=7

And lastly, what is the realistic scope of my involvement at scenes of death or medicolegal autopsies?

I am currently on my ME rotation right now. A site that was recommended to me that I have found pretty useful is pathologyexpert.com. In that site there are a collection on notes on forensic pathology, some of which are more detailed than what we Pathology residents need to know, but it has some good basic info. If you register, you can get access to some of the lectures (with pics).

Try and get as much scene and court exposure as possible-- it is pretty fascinating. I absolutely hated medical autopsy, but have been pleasantly surprised during my time at the ME (and even enjoy it!).

 

[Packamylase]

I'm a 3rd year medical student doing a Clinical Path rotation in April. What suggestions do you have for me? Anything I should be particularly mindful of? I'm interested in Path and this is my first Path rotation.

 

[SLUsagar]

I'm a 3rd year medical student doing a Clinical Path rotation in April. What suggestions do you have for me? Anything I should be particularly mindful of? I'm interested in Path and this is my first Path rotation.

if you're considering path, PLEASE also do a rotation in surgical pathology. you may get a very misleading view if on CP (clin path) you see a bunch of residents falling asleep in their cubicles pretending to read Henry (clin chemistry book). While other parts of CP are indeed cool, please do yourself a favor and sign up for a surgpath rotation.

 

[Packamylase]

if you're considering path, PLEASE also do a rotation in surgical pathology. you may get a very misleading view if on CP (clin path) you see a bunch of residents falling asleep in their cubicles pretending to read Henry (clin chemistry book). While other parts of CP are indeed cool, please do yourself a favor and sign up for a surgpath rotation.

I definitely will - Thanks! Rock Chalk Jayhawks!!