How hard is Pathology?

[pathman1]

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Hey guys--i am pretty focused on going into pathology, i just wanted to get some of your opinions on the following: The difficulty of the field. Path, as we all know is a very broad spectrum field (of course you can subspecialize--which narrows it up), but it is still a whole bunch of information! Other fields like Anesthesia, are more narrow in terms of knowledge base. I like routine things, so they are easier to master--which means less studying. Do you guys consider path a "routine" field, b/c once you see something enough you can point it out in your sleep. Also how difficult would you say the subject of pathology is compared to other fields. I know that the path residency is very nice compared to other fields, but is the knowledge in pathology tougher to grasp? I know difficulty of a field is a very subjective thing and varies from person to person, but it would be great if you guys could give me some of your ideas/opinions.

 

[b&ierstiefel]

IMHO, pathology is just a different field from a lot of the other fields out there. As you state, pathology is a broad spectrum field and I agree with you on that. In that respect, being that there is so much to learn and grasp in pathology, I think pathology will be a challenging residency and career. Sure, if you subspecialize it cuts down on what you really have to know; in turn, you will know a lot about little.

I don't know if the material in pathology is harder to grasp though. It's just different. For instance, surgical pathology is very visually oriented. So if you're good with visual pattern recognition then pathology should be easier. But if you are not visually oriented, then you may have a more difficult learning curve waiting for you.

And like other fields, once you learn the pathology and are used to applying it on a day to day basis, I'm sure it will become routine.

 

[cytoborg]

From talking with residents and faculty, it sounds to me like the information in pathology is not harder to grasp per se, there is just a huge amount of it compared to other fields. For instance, I've heard IM attendings say that you "learn how to practice medicine" during your intern year. And not so long ago, people were completing only one year of residency before going out into practice as GPs. I'm fairly certain that after one year of pathology residency, none of us is going to feel remotely qualified to sign out slides unsupervised. I'm not saying other fields are easier by any means (in fact, one of the most frequent discussions around this form has to do with the many challenges of clinical medicine). But perhaps there is a difference in the volume of information that must be mastered, and in the amount of independent reading that must be done in addition to your time in the hospital.

 

[stormjen]

I have a hunch that some residents can coast through residency without doing hours of reading each week. This hunch is based on my experience rotating at a community Path program where I rarely saw anyone reading a textbook, other than cursory scans of the text and studying the images.

At the same time, I was not at all impressed by the quality of the more senior residents. Sure, they could identify the bread and butter lesions, but challenge them with something more rare or ask them in-depth questions and they were lost.

Beyond any innate ability to read slides, I think the field is as difficult as you want it to be. If you want to excel and be considered knowledgeable in the field, then there is definitely a baseline level of knowledge that must be assimilated during residency. And if you want to be an expert, then you have to go on and do a fellowship in your sub-specialty of interest. But if you want to be simply competent, then you can probably make it through residency without busting your butt reading all the time. The difficulty then would be managing the surg path hours and learning enough to get by.

Side note: I often feel silly posting about residency and the career as if I know what I'm talking about from experience. The fact is, I won't have the real picture until I've experienced it myself. But these are my thoughts as a fourth year med student who has done three months of Path and gone through the interviewing process.

 

[dpdoc]

Something neat about pathology, particularly surgical pathology, is that you keep learning… A LOT, after you finish your training. Particularly the first few years you start signing-out cases on your own. After two busy fellowships and passing the boards, I have to open books several times a day 😕 , to figure-out cases.

 

[geddy]

Hey guys--i am pretty focused on going into pathology, i just wanted to get some of your opinions on the following: The difficulty of the field. Path, as we all know is a very broad spectrum field (of course you can subspecialize--which narrows it up), but it is still a whole bunch of information! Other fields like Anesthesia, are more narrow in terms of knowledge base. I like routine things, so they are easier to master--which means less studying. Do you guys consider path a "routine" field, b/c once you see something enough you can point it out in your sleep. Also how difficult would you say the subject of pathology is compared to other fields. I know that the path residency is very nice compared to other fields, but is the knowledge in pathology tougher to grasp? I know difficulty of a field is a very subjective thing and varies from person to person, but it would be great if you guys could give me some of your ideas/opinions.

For me, I think path is a little tougher than clinical specialties becuase of the steep learning curve. We are much more exposed to medicine, srugery, etc. in med school, and so I think the transition is easier to residency. I've been told that path can be like starting from scratch all over again.

 

[DrBloodmoney]

The amount of knowledge, particularly in subspecialty pathology, is staggering. However, in order to be a good general pathologist, you only need to learn medicine AND surgery.

Sometimes pathology makes me feel very, very dumb.

 

[Doctor B.]

Attending at microscope: "What's this structure?"
Med student: "A blood vessel?"
Attending: "No! It's a nerve. What's this lesion? Give me an educated guess."
Med student: "Uh...well...carcinoma?"
Attending: "Wrong! I said an EDUCATED guess! Pathology is hard!"

A somewhat paraphrased encounter with one of my attendings to illustrate the point that pathology IS hard. There is a ton of information to know for boards. Thankfully, once you get into practice, you can hone your skills and knowledge to the specific areas you are working in.

 

[DrBloodmoney]

Attending at microscope: "What's this structure?"
Med student: "A blood vessel?"
Resident: [not knowing the structure, begins describing the one next to pointer... just not the one the attending meant]
Attending: "No! It's a nerve. What's this lesion? Give me an educated guess."
Resident (right way to dodge): "looks like a well-encapsulated neoplasm, containing a moderate amount of vascular structures and intervening fibrous stroma. There appears to be a proliferation of pleomorphic atypical cells arranged in trabeculae and nests, with a varying amount of cytoplasm and poorly defined cell borders. The nuclei are angulated with small-to-large (classic bs language) nucleoli and a finely reticulated (pouring on the bs now) chromatin pattern--"
Attending (bored and frustrated): "What is your diagnosis then"
Resident (clueless): 'I think I'll go descriptive on this one and throw in the 'clinical correlation' comment."

[and end scene]

Classic... residency is fun

 

[deschutes]

Attending focuses on high-power field of kidney parenchyma containing one glom and says, "Everything you need to make the diagnosis is contained within this field".

*bangs head*

 

[b&ierstiefel]

Glomeruli ROCK! They're so purty!

 

[deschutes]

...inevitable derailment looms...

Back in high school I came across the KnotPlot Site

 

[b&ierstiefel]

neat-o

 

[stormjen]

I love glomeruli too. They became an interest of mine early in med school. Now if I could find a way to turn them into a moneymaker, I'd be set. Maybe I'll write a book about how wonderful they are. Hmm.

 

[Doctor B.]

Attending at microscope: "What's this structure?"
Med student: "A blood vessel?"
Resident: [not knowing the structure, begins describing the one next to pointer... just not the one the attending meant]
Attending: "No! It's a nerve. What's this lesion? Give me an educated guess."
Resident (right way to dodge): "looks like a well-encapsulated neoplasm, containing a moderate amount of vascular structures and intervening fibrous stroma. There appears to be a proliferation of pleomorphic atypical cells arranged in trabeculae and nests, with a varying amount of cytoplasm and poorly defined cell borders. The nuclei are angulated with small-to-large (classic bs language) nucleoli and a finely reticulated (pouring on the bs now) chromatin pattern--"
Attending (bored and frustrated): "What is your diagnosis then"
Resident (clueless): 'I think I'll go descriptive on this one and throw in the 'clinical correlation' comment."

[and end scene]

Classic... residency is fun

LOL! I think I've been through that exact scenario about a hundred times (so far...).

 

[yaah]

Path is hard...but you can make it easier if you don't try to learn everything. There is basically an infinite amount of material to learn on a number of esoteric lesions that no one has ever heard of. Sometimes I talk to clinicians about biopsy results and tell them the diagnosis and they say, "What is that?" And sometimes after that they ask if I know anything about prognosis, or even treatment. Sheesh.

There are shortcuts in some areas, but not in others. To become good at interpreting the tough frozen sections you have to spend a lot of time doing them. And you have to read a lot.

Residency is not a cakewalk either. My day yesterday:

6:30-7:30 organize things
7:30-9:00 conferences
9-noon signout
noon-1pm brain conference
1-1:45 consensus conference
2-9pm gross and preview all of next days cases
9-10 prepare for presentation had to give at morning report that I found out about during the day.

Lifestyle! Lifestyle! But the thing is I am having fun and learning a lot, so I don't mind the hours.

 

[b&ierstiefel]

Residency is not a cakewalk either. My day yesterday:

6:30-7:30 organize things
7:30-9:00 conferences
9-noon signout
noon-1pm brain conference
1-1:45 consensus conference
2-9pm gross and preview all of next days cases
9-10 prepare for presentation had to give at morning report that I found out about during the day.

Lifestyle! Lifestyle! But the thing is I am having fun and learning a lot, so I don't mind the hours.

I think this is what is ultimately important. Rock on man! Go have a drink...reward yourself.

 

[yaah]

I think this is what is ultimately important. Rock on man! Go have a drink...reward yourself.

Dude I don't need a drink I need to go to sleep. Good thing that girl is busy too otherwise we'd probably be on the phone or something. 😳

 

[b&ierstiefel]

Dude I don't need a drink I need to go to sleep. Good thing that girl is busy too otherwise we'd probably be on the phone or something. 😳

fine go to sleep then. i'm stayin up.

 

[bananaface]

Dude I don't need a drink I need to go to sleep. Good thing that girl is busy too otherwise we'd probably be on the phone or something. 😳

It strikes me as funny that she is keeping you up late. Usually that makes you really cranky.

 

[yaah]

It strikes me as funny that she is keeping you up late. Usually that makes you really cranky.

Yeah I know. Weird, eh? But SDN is keeping me up late tonight and I am getting cranky. Go figure!

 

[bananaface]

Yeah I know. Weird, eh? But SDN is keeping me up late tonight and I am getting cranky. Go figure!

That's cause you aren't distracted by the possibility of sex.... Duh.

 

[yaah]

That's cause you aren't distracted by the possibility of sex.... Duh.

Ha! Perhaps so. I am tired of living in possibilities!

 

[bananaface]

Ha! Perhaps so. I am tired of living in possibilities!

I am tired of no possibilities! 😡

[/rant]

 

[yaah]

I am tired of no possibilities! 😡

[/rant]

Well, that was me a couple weeks ago, and it was actually kind of liberating. Now if it doesn't happen I will just get more cranky.