How to study? Effective Learning

[GooseIsland52]

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Hello all,

As the first year of residency is coming near the end, I have found myself wondering how much I have actually learned. I can't say I have read that much this year. I think some of this stems from the fact that I am not sure how to approach the vast knowledge base...some of the questions I have: Do I need to have mastered fiirst 9 chapters of Robbins before delving into the organ systems? Can I go straight to a surg path text like MSP/Rosai/Sternberg? I feel like I have a weak foundation, obviously its my fault - but any help would be appreciated.

 

[gbwillner]

Hello all,

As the first year of residency is coming near the end, I have found myself wondering how much I have actually learned. I can't say I have read that much this year. I think some of this stems from the fact that I am not sure how to approach the vast knowledge base...some of the questions I have: Do I need to have mastered fiirst 9 chapters of Robbins before delving into the organ systems? Can I go straight to a surg path text like MSP/Rosai/Sternberg? I feel like I have a weak foundation, obviously its my fault - but any help would be appreciated.

Forget Robbins.... this is a med school text. It may be useful to brush up on things for the boards. It's actually shocking to hear you are at the end of your first year and have not looked at Rosai/Sternberg. You should be looking up each case you get. How else are you learining? How do you make a Dx? Do you just show the atendings the case without making a Dx first?

I guess it depends on volume. I am at a high-volume program, so I don't have time to just sit and read Rosai for fun (although other residents still find time). If I got something I hadn't seen before, I took out the appropriate book and read to make a Dx. Once I thought I had the Dx, I read about that entity. If I was right, hurrah. If I was wrong, I would look up/hear about the correct Dx. If you at are a low-volume place you have plenty of time to read about any topic you choose with all your spare time.

 

[gschl1234]

Hello all,

As the first year of residency is coming near the end, I have found myself wondering how much I have actually learned. I can't say I have read that much this year. I think some of this stems from the fact that I am not sure how to approach the vast knowledge base...some of the questions I have: Do I need to have mastered fiirst 9 chapters of Robbins before delving into the organ systems? Can I go straight to a surg path text like MSP/Rosai/Sternberg? I feel like I have a weak foundation, obviously its my fault - but any help would be appreciated.

During my first year I read all of Molavi (v. short and easy book) and used WashU SP manual as a reference. Now I mostly read pathologyoutlines and random organ-based textbooks (e.g. the biopsy interpretation series, Blaustein's, WHO series) for SP. I'm reading Cibbas and the Bethesda books for cyto. I'm not a huge fan or Rosai or Sternberg. If you like general books, might also consider Silverberg. For CP I listent o ASCP lectures and read bits of Henry's here and there. Will plan on reading the first 9 chapters of Robbins for board review tho.

 

[pathstudent]

You should read about each case you see the first time you see it, if there are new or unusual features in cases that you routinely see, and in cases that you have not seen in awhile.

Any text is fine, whether it be a thick subspecialy path book, general surg path text, a journal article, an atlas or a review book. The important thing is just to read.

 

[KeratinPearls]

You should read about each case you see the first time you see it, if there are new or unusual features in cases that you routinely see, and in cases that you have not seen in awhile.

Any text is fine, whether it be a thick subspecialy path book, general surg path text, a journal article, an atlas or a review book. The important thing is just to read.

Agree you need to read about your cases. Forget about using Osler for now. Read about the cases you see whether it be the cases you gross/sign out, see at gross conference, hear at departmental conferences. If you see it again later in your residency, read about it again...and again. There is a vast amount of information but you have to at least read what you encounter during residency. You can read about the zebras once you get a firm grasp on general bread and butter pathology.

You need to develop a system of repetition. Take notes and review them over and over again. For CP, focus on Compendium and just know that book cold. If you need to, refer to Henry's when you dont understand something. Read about things you encounter during your rotations. Good luck.

Oh I also recommend you carry a spiral notebook and consistently take notes from signout, lecture and your readings in it. Carry the notebook around throughout your residency and keep on reviewing it.

In the end, you have to be able to read and retain a lot of information. In the end, you have to realize you can't possibly master everything. Just do the best you can.

 

[caffeinegirl]

I agree with the above postings..

I learn best by doing, not by sitting and reading chapters of a text. So, I tailored my reading to the cases I had to preview that day, and read about the diagnoses the first time they showed up. Also, reading about the cases presented at unknown conferences helps a ton (we had daily unknown conferences that were subspecialty based, which allowed you to focus your studying).
However, there will inevitably be gaps in knowledge using this approach, since it's dependent on the cases you see... I used by time for studying for boards to really hunker down and read as much as I could, by using question books (such as Lefkowitch and Sternberg) and reading about each diagnosis listed as answer choices.

 

[Ombret]

Sternberg, Rosai and their ilk may be hard to appreciate as a lower year resident. Give them a try, but don't invest major dollars in them if you haven't already. Eventually, you will get a lot out of them. By the way, Sternberg is probably better for learners (my opinion only). Rosai is more useful once you already know the diagnosis and want to see what the Great Man has to say about it. In the long run both are obviously superb.

I agree with what's been said; read about your cases. If you are seeing an adequate case mix then you will end up reading about a lot of things. Be alert to gaps in your cases (no eye pathology at your institution, etc.) and fill those in with other materials: reading, PathXchange, whatever. Also be alert to things you keep missing. If you make a mistake twice--or even once--then read about whatever prompted the mistake.

I personally have gotten a lot of mileage out of the book Differential Diagnosis in Surgical Pathology, because it specifically talks about what should be in your differential and how you can resolve it, for any given lesion.

Robbins is a great text with very clear explanations by some of the greatest pathologists, but I agree with gbwillner, it is pretty much a lowest common denominator once you become a path resident. Circle back around to the general path portion of Robbins when it's time to study for boards. (Although, if you are not yet up to the Robbins level of knowledge--by all means plow through that book in a hurry.)

 

[lipomas]

Don't forget about Robbins for boards though. Lots of questions come right out of there - particularly neuropath, genetic stuff, cardiac stuff.

 

[pathstudent]

Sternberg, Rosai and their ilk may be hard to appreciate as a lower year resident. Give them a try, but don't invest major dollars in them if you haven't already. Eventually, you will get a lot out of them. By the way, Sternberg is probably better for learners (my opinion only). Rosai is more useful once you already know the diagnosis and want to see what the Great Man has to say about it. In the long run both are obviously superb.

I agree with what's been said; read about your cases. If you are seeing an adequate case mix then you will end up reading about a lot of things. Be alert to gaps in your cases (no eye pathology at your institution, etc.) and fill those in with other materials: reading, PathXchange, whatever. Also be alert to things you keep missing. If you make a mistake twice--or even once--then read about whatever prompted the mistake.

I personally have gotten a lot of mileage out of the book Differential Diagnosis in Surgical Pathology, because it specifically talks about what should be in your differential and how you can resolve it, for any given lesion.

Robbins is a great text with very clear explanations by some of the greatest pathologists, but I agree with gbwillner, it is pretty much a lowest common denominator once you become a path resident. Circle back around to the general path portion of Robbins when it's time to study for boards. (Although, if you are not yet up to the Robbins level of knowledge--by all means plow through that book in a hurry.)

Robbins focuses on Pathophysiology and pathobiology. It is intended to be studied and mastered by all physicians, it was not intended to be used as a surgical pathology textbook.

 

[GooseIsland52]

Ok so I may have been slightly misunderstood...gbwillner - I definitely do pull out a surg path text when I am previewing my cases in an attmept to make a diagnosis before signout. However, I feel as though this is scatterbrained reading if you get my drift...by the end of the day I will have "picture matched" and read around some of the entities I encounter, but I cant' fit them into a framework. For example, if I encounter a borderline intestinal-type mucinous tumor of the ovary...great, I will read about it and look at pictures...but the basics on the entire spectrum of ovarian neoplasms is lacking...this is why when I read at night, I end up starting a chapter cold and only make minimal gains. So...the solution...plow through Robbins to get a framework?

 

[Euchromatin]

I also found the Molavi extremely helpful, especially at the very beginning of the year when everything was rather overwhelming, and I have loaded all the margins with additional notes from other texts, lectures, and tips from attendings I picked up at signout.

I've found that the Robbins was good for a lot of entities that come up in autopsies, or stuff that is considered so basic that it isn't covered in surg path texts (e.g. aortic dissections, pulmonary emboli, myocardial infarction, etc.). It is decent for a quick overview of the most common entities in a particular organ system, but detailed discussions of the histologic features are often lacking.

Our program provided us with the newest Sternberg at the beginning of year, but I haven't really found it all that useful, at least on its own, frankly. I tend to have better luck looking up pictures on Pathology Outlines and other internet sources, and using an organ-system specific book (i.e. I love Crum and Lee for gyn, Odze for GI/pancreas, etc.), and maybe even a good review article from a path journal.

To address GooseIsland52's specific question - when reading about cases on a day to day basis, I try to cover not only the specific entity, but also the top few others in the differential diagnosis and/or related to that entity. To use your example, I would not only study the features of mucinous borderline ovarian tumors, but also benign and malignant mucinous lesions, mucinous-appearing metastases to the ovaries, etc. And maybe if I had several cases of ovarian epithelial lesions that day/week and wanted to read about the whole spectrum, I would write down that topic on the running list I keep of what to study next.

I try to choose organs we don't see very often, or more rare/zebra entities in common organs for talks/presentations we are required to give periodically. I usually find that material I've read will stick much better if I have slides to look at while I go, so, especially if I have a bit of extra time, I will look up and pull a few good slides from cases in our stores or ask around to see if anyone has a study set that is related.

 

[Patho2009]

In short, your learning should be case-based. Read about the cases you encounter from any book you like and know how to distinguish every lesion from its mimickers/differentials. The book of (differential diagnosis in surgical pathology) is very good to start with.

 

[Ombret]

GooseIsland52, your point is well taken: reading about specific topics seems scattered and unsystematic. But pathology, or AP, or surg path, or even any single subspecialty is too big to fit into your mouth whole. You will inevitably have to nibble around the edges. This is why your training takes multiple years. If you are diligent about taking these small bites, by the end you will have eaten a complete meal. I think other senior residents and fellows would agree with me on this.

 

[gschl1234]

Ok so I may have been slightly misunderstood...gbwillner - I definitely do pull out a surg path text when I am previewing my cases in an attmept to make a diagnosis before signout. However, I feel as though this is scatterbrained reading if you get my drift...by the end of the day I will have "picture matched" and read around some of the entities I encounter, but I cant' fit them into a framework. For example, if I encounter a borderline intestinal-type mucinous tumor of the ovary...great, I will read about it and look at pictures...but the basics on the entire spectrum of ovarian neoplasms is lacking...this is why when I read at night, I end up starting a chapter cold and only make minimal gains. So...the solution...plow through Robbins to get a framework?

I hear ya. One quick way to get the birdseye view is to look at the table of contents. In the case of your ovary example, a quick peak at the table of contents of Blaustein's would tell you that (generally) you can think of ovary tumors as epithelial, sex cord stromal, germ cell, metastatic and misc. Then looking more closely at the epi subheadings, you'll see that the general varieties (serous, mucinous, endometrioid, Brenner) come in 3 varieties each (b9, atypical proliferative/borderline, malignant). There are other epi tumors that are oddballs (squamous, MMMT)...etc....So prior to diving into the chapter, you can get an idea of organization this way so you don't get lost in the details as you start reading. Or if you don't have time to read the chapter(s), taking a look at the contents will at least familiarize you with the categories.

 

[KCShaw]

Whether unfortunate or not, residency isn't like school where most of what you need to know is pre-processed, packaged, and fed to you. Some portion of residency I think is often spent trying to figure out how you can go about packaging what you need to know in a way that helps you go about learning it. Some people were forced to learn this in medical school, and some residency programs are fairly structured and may also help you with this -- but many have to figure it out on their own.

For you that may mean reading a certain chapter in Robbins then reading the corresponding chapter in one or more surg path texts. Or it may mean looking at slides and choosing some of your differential diagnoses of the day and searching to only read about those specific differentials, things that you think look alike. Or some other method. It depends on what keeps you most involved and productive.

You'll realize how much you have or haven't learned when the new 1st years come in. If they're regularly a step ahead of you at unknown conferences or when sharing discussion of cases, then you'll know you have a lot of work to do. But that generally isn't the case, and in many ways it's nice to suddenly recognize you -did- learn something..