Getting the most out of MSIII from Path perspective

[Deucedano]

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Im 2 weeks into my path rotation (2nd of MSIII) and Im almost positive that I will be going into pathology. I cant see myself changing my mind during my third year. I know I should focus on doing well on shelfs and getting good evals, but I was wondering what I should do to get the most out of third year from a pathology perspective? Is there a book that has clinical info with a path focus?

I find that I cant really learn why things are done diagnostically unless I understand the disease process, so I think this kind of text would help me retain the clinical info and brush up on path. I just want to keep up the path I worked so hard to learn over the past two years.

 

[KCShaw]

I seem to recall stumbling across a few specialty books which claimed to be X with a pathology focus, but most that I flipped through, however briefly, seemed to be clinical texts with general medical school pathophysiology. Not really good correlates with the actual practice of pathology. But if I could only choose 1 book for what I think you're asking, it would still probably be Robbins -- basic science pathophysiology, but also more clinicopathologic correlation with semi-practical day-to-day pathology. It's just not that detailed from either the clinician's or pathologist's perspective. Maybe someone else knows a better single concise text.

Really, spending a lot of time in the path department on your rotation, and other times when you can, will give you the most realistic idea of the differences between what most pathologists do day-to-day, vs just understanding the pathophysiology of a disease process.

 

[somber]

I am also a third year student. I am 100% sure that I am going to do pathology.

I have already encountered a lot of tumors that are not in Robbins during my first month of third year. I bought myself Sternberg's Diagnostic Surgical Pathology last week. I am going to try to use it to read about my patient's tumors and also just to read when I am bored of clinical stuff. Looking through the book sort of motivates me by reminding me how much I have to learn and also by exposing me to histopathology which is the aspect of medicine which I most enjoy. Not sure if this is a waste of time or not, but I am enjoying it. Perhaps if I read it for 1hr per day I will have a decent head start when residency begins?

I purchased the Robbins Atlas last year and it was my favorite book throughout second year. It had just enough text that it helped with learning the key clinical details and translocations and stuff for my tests while also have lots of pictures which made it fun to use. It also had enough space that I could add my own notes to it. Perhaps I should add a more comprehensive pathology atlas to my collection? Any atlas suggestions?

 

[simplesuture]

I am also a third year student. I am 100% sure that I am going to do pathology.

I have already encountered a lot of tumors that are not in Robbins during my first month of third year. I bought myself Sternberg's Diagnostic Surgical Pathology last week. I am going to try to use it to read about my patient's tumors and also just to read when I am bored of clinical stuff. Looking through the book sort of motivates me by reminding me how much I have to learn and also by exposing me to histopathology which is the aspect of medicine which I most enjoy. Not sure if this is a waste of time or not, but I am enjoying it. Perhaps if I read it for 1hr per day I will have a decent head start when residency begins?

I purchased the Robbins Atlas last year and it was my favorite book throughout second year. It had just enough text that it helped with learning the key clinical details and translocations and stuff for my tests while also have lots of pictures which made it fun to use. It also had enough space that I could add my own notes to it. Perhaps I should add a more comprehensive pathology atlas to my collection? Any atlas suggestions?

you know what impresses attendings once your start your first year of path? knowing your clinical ****. understanding what the words on your reports are going to do to a human being. all first year path residents get pimped on is clinical stuff. no attending will think less of you if you don't know specific genes or rare tumors, but you're gonna look like an a-hole if you can't remember what graves disease is.

 

[KCShaw]

Kinda true. I remember being asked an absurd amount of epidemiology and such in first year. I also remember a few attendings commenting (in a good way) about things I picked up having done a clinical intern year. That's not to say you won't impress by being able to accurately differentiate multiple soft tissue tumors by histology on day 1, but programs expect to have to show and teach you that.

If you're at the point where you well and truly know you want to go into pathology, including having done rotations (at least 4 weeks), sat around the scope, been exposed to grossing, etc., then look at some of the textbook threads on this forum. Already having Sternberg, I probably wouldn't recommend splurging on something else unless you're really starving. For the most part, reading through that will put you in very good stead before you start if you're already intimate with Robbins. Just don't let the rest of med school pass you by in the meantime.

 

[somber]

all first year path residents get pimped on is clinical stuff. no attending will think less of you if you don't know specific genes or rare tumors

Should the goal of one's medical education be to impress attendings?

 

[KCShaw]

There's a thread on "gunners" right now which might draw mild attention.

"The" goal? No. "A" side effect? Well, realistically, yes.

Not always, but in general, if they know what they're doing then if you truly positively impress an attending it's because they feel you've learned something applicable to your education and/or real-world practice. There is, of course, a potential disconnect between knowing your stuff and being a good medical practitioner in your specialty; you're not going to be effective if no-one trusts or respects you, or if what you've done to impress wasn't relevant -- or merely involved sabotaging everyone else around you while you haven't really learned that much. But we're kinda getting into niche territory there.

It's wise to have an understanding of what attendings generally want and expect. Make your own decisions as to how you apply it.

 

[yaah]

Your goal during MSIII should be to learn as much about these other fields as you can. if you understand how they work and how clinicians operate, it will help you out as a pathologist. It will also help out the results you provide because they will be more informed and clinically relevant.

You should also keep your mind open. You may discover another field draws you in more than pathology and you want to pursue that instead. Just don't make the mistake of giving third year a half-hearted effort because it "isn't relevant" to what you think you will be doing.

 

[simplesuture]

Should the goal of one's medical education be to impress attendings?

you missed my point. there's more than enough time to learn about path during path residency. concentrate on the stuff you're not going to learn during your residency now while you have the chance. it'll make you a better pathologist later.

 

[Autopsy Sweet]

concentrate on the stuff you're not going to learn during your residency now while you have the chance. it'll make you a better pathologist later.

This is what I tell every rotating medical student who tells me they're doing 4 pathology electives in their fourth year, and I've heard many of my attendings say the same. You'll never have another opportunity to learn clinical derm or cardiology or rheumatology, or whatever (fill-in-the-blank). Take the opportunity now and save your pathology learning for your residency. And take Step 3 as soon as humanly possible after you graduate! You'll really appreciate it later.

 

[deleted314957]

Simplesuture has a great point. The 1st week of my residency Dr. Robert Dufore tried to pimp me. He was a 1st or 2nd year staff at the time and was BIG into clin chemistry ( now is on the national lecture curcuit for same and got his clin chem boards while i was in the military with him) and his big deal at the time was parathyroids. I had a surg internship and 2 years gp practice before and he approached me and "harrumphed" you did a surg internship--- what is the vascular supply of the parathyroids? I thought a moment and gave the correct responce to which he replied "that would be incorrect". In about 10 minutes I showed him Gray's ( i was right)
and he skulked off. Not a big problem in the Military because rank among physicians was like rank among ****** in that situation/those days (1981).

I don't want to knock the guy at all because he has done a tremendous job of teaching clin chem to lots of res's like Seymour Bakerman did and i have lots of respect for him. It was just a little coup by a new resident and we always had a cordial relation. BTY, he and his wife Mary were (are?) gourmet cooks and folks from the dept did
group classes dept. at his house when I was a res.

This was a GREAT example of knowing your clinical shi*!

 

[KCShaw]

...rank among physicians was like rank among ******...

Such an opportunity. Actually, I was under the impression that failure to observe rank among the latter could get one CUT.

I remember my (much more limited) clinical background holding me in better stead than some other path residents simply by virtue of understanding how harried most of the residents in other programs were, what they really wanted to know from me, and how I could help them without screwing things up for the patient. These days it helps during conversations with clinicians who don't know what to do with a death certificate, or understanding why a trauma surgeon was focusing on X when my office really wants to know Y.

Not to say we should require every path resident do a clinical intern year, or become clinicians before sidestepping into pathology, but there's a reason we require everyone to, y'know, finish med school.

 

[sirenomelia]

Try to publish a case report or something. That can really help demonstrate your scholarly interest and show top programs you will be a productive resident.