PSF With Question on How to Remember the Clinical Information

[tco]

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I'm a post-sophomore fellow in pathology and I feel that I'm forgetting everything that I have learned from years MSI and MSII. I've all but decided that pathology isn't for me, so I feel that the year has been helpful, but now I'm now starting to worry that I won't be able to recover from being away from clinical medicine for the year.

Does anyone have any thoughts on this? I do enjoy pathology, and have been trying to learn along with the first years, but I don't enjoy it enough to make a career out of it. With that in mind, would you suggest that, rather than reading up on all things pathology for my interesting cases that I try to look up the clinical presentations, pathophys, pharm, etc associated with them instead?

I've been thinking about doing rounds with a local group that serves the homeless to try to keep up my physical exam skills, because I'm afraid that I've forgotten those as well!

Thanks in advance.

 

[lipomas]

"physical exam skills" lol. While I am sure there are a handful of physicians who these days actually use the physical exam to make a diagnosis, they are in the minority except for the occasional specific maneuver. On a worry scale of 1 to 10 where 1 is panic over how to spend a $1 million windfall when you already have a billion in the bank, and 10 is being surrounded by 10 big men who all want to kill you, keeping up your physical exam skills is about a 1.1.

As far as the other thing, which is also a minor worry, just pay attention during your clinical years, read about the pathology perspective on things that come up. But try to learn clinical medicine because it will help you be a better pathologist.

 

[Euchromatin]

I wouldn't worry too much. I found that the skills you use to round on patients on a day to day basis (i.e. physical exam, writing H&P and SOAP notes, checking labs, etc.) aren't taught all that well in the first two years and you'll pick them up pretty quickly in the first few days of each of your clinical rotations. You could certainly focus more on looking up the clinical histories of the patients whose biopsies/resections you are seeing in path if you wanted (although I don't think it will be very helpful for your basic internal medicine, surgery, psych, neuro, etc. patients).

 

[mlw03]

I would not suggest what you asked. You're doing a PSF, and it's great that you've figured out path isn't for you. I know tone doesn't convey well in text, but I'm not being sarcastic. However, you'll have the rest of your career to do IM, surgery, ob/gyn, or whatever you pick. This is your one year to learn some real pathology, which will be a big help during your residency and beyond. While I wouldn't spend too much time grossing or memorizing IHC profiles since you're not going to be doing this long-term, I do think you should work hard at your diagnostic skills and see the limitations of histopathologic and cytopathologic diagnosis. I think too many docs think our diagnoses are pure gold, and sometimes they are, but sometimes not. Use this year to learn that and you'll be well-served in the futured.

 

[Enkidu]

I'm a post-sophomore fellow in pathology and I feel that I'm forgetting everything that I have learned from years MSI and MSII. I've all but decided that pathology isn't for me, so I feel that the year has been helpful, but now I'm now starting to worry that I won't be able to recover from being away from clinical medicine for the year.

Does anyone have any thoughts on this? I do enjoy pathology, and have been trying to learn along with the first years, but I don't enjoy it enough to make a career out of it. With that in mind, would you suggest that, rather than reading up on all things pathology for my interesting cases that I try to look up the clinical presentations, pathophys, pharm, etc associated with them instead?

I've been thinking about doing rounds with a local group that serves the homeless to try to keep up my physical exam skills, because I'm afraid that I've forgotten those as well!

Thanks in advance.

I'm in a fairly similar position as you because I'm away from medical school doing my PhD, so I have to work not to forget whatever clinical skills I have before I go back to Med 3. On the other hand, I do want to eventually go into pathology.

To be honest, though, I don't think you have much to worry about. Pathology is the basis of medicine, and understanding it will put you ahead of your peers at understanding disease. Pharmacology follows pathology, so that's not too difficult. If you know that a disease is inflammatory, or a type I hypersensitivity disorder, or the degeneration of dopaminergic neurons... the broad treatment is obvious from this. Exactly which drug and how much to give doesn't really follow, but I never learned that stuff in medical school anyway, I guess that's what the clinical years are for.

As far as pathophysiology goes, I guess you mean things like stroke volume and pulmonary wedge pressure in a patient with heart failure. But to me these are also the same as pathology. Why do patients with heart failure get heart-failure cells? Why do their hearts dilate? If you understand the gross and histological features of heart failure, then that pathophysiology is also obvious. I think it's the same with everything, form always dictates function.

Yeah, don't bother with learning the IHC profile of every tumor or learn how to gross a whipple, but try to understand the fundamental nature of disease. Medical students get confused because they gloss over the fundamentals and try to learn fancy clinical signs and focus on what they think is "clinically applicable", but they can't reason through a diagnosis because they never got a proper foundation in pathology. I would take this year gain that foundation well, and then you will find that everything else just falls into place.

Physical exam skills? I've forgotten those too, and good riddance. But volunteering at the homeless clinic is probably a good fix for that, since those skills are definitely going to get rusty in pathology.

 

[Ombret]

During your PSF you are thinking about "clinical" medicine all the time. Understanding the indications for the procedures the patients are undergoing, seeing how the surgeons manage their patients in the OR (through the lens of the frozen bench)--these will be useful for MS3/4, not to mention your eventual specialty, in a thousand small ways. After serving more or less as a resident for a year, you will also hopefully come to clerkships with more of a resident's mindset, which will make you a much better student and team member.

 

[KCShaw]

And of course if you end up in surgery, the experience in pathology (including grossing) will be helpful. I tend to agree with those who suggest continuing to focus on the pathology since that's what you're doing, if perhaps with more of a mind towards its intersection with the other specialties, one of which you will evidently end up in. You have 2 more years of medical school to experience as many different specialties and approaches as possible before you get more or less locked into one specialty and probably do only that for the rest of your career/LIFE. Make the most of the available time to see and do different things, meanwhile don't ignore what's right in front of you solely because it's not your likely career path.

You also have 2 more years to learn/re-learn the basics of H&P. I don't know anyone who looks back and thinks, gosh, I wish I had practiced H&P's more between 2nd and 3rd year (unless, I guess, they failed that part of the practical in med school)... You'll see and do plenty, with more than enough supervision/feedback, over the next 2 to 6 years or so, with I suspect plenty of time to prep for those parts of USMLE/clinical skills (if they're still requiring that).

 

[Concubine]

I'm a post-sophomore fellow in pathology and I feel that I'm forgetting everything that I have learned from years MSI and MSII. I've all but decided that pathology isn't for me, so I feel that the year has been helpful, but now I'm now starting to worry that I won't be able to recover from being away from clinical medicine for the year.

Does anyone have any thoughts on this? I do enjoy pathology, and have been trying to learn along with the first years, but I don't enjoy it enough to make a career out of it. With that in mind, would you suggest that, rather than reading up on all things pathology for my interesting cases that I try to look up the clinical presentations, pathophys, pharm, etc associated with them instead?

I've been thinking about doing rounds with a local group that serves the homeless to try to keep up my physical exam skills, because I'm afraid that I've forgotten those as well!

Thanks in advance.

Don't worry about it. I also did a PSF, and you'll transition back into 3rd year without any problems. The physical exam/writing notes stuff will come back to you, and you'll find you do just as well as you did before on exams. Learn as much about pathology as you can, and in the mean time enjoy your weekends off and good hours. Pathology is the basis for all medicine, and it will help you at least a little in your clerkship years and beyond. In all seriousness, it's a good thing that you have figured out you don't want to do pathology at this point, since that is kind of the point of doing a PSF.

If you have extra time and really want to start figuring out what you want to do, I say go ahead and hang out with the fields you are interested in and at least get a little exposure. Pathologists often mix with lots of specialties during conferences, so you could attend these and learn about the pathology side of whatever other specialties you are interested in.