Question for those that have gone before

[DarksideAllstar]

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After doing a few unfruitful searches, I gave in and decided to pose this question to y'all (no I am not Texan)...
When doing path electives as an M4 what is expected of you? I know this probably varies from program to program, but I am somewhat anxious about the experience, as I will not have looked at any histopath (or histo for that matter) for quite sometime.
Any advice on how to approach these electives would be much appreciated.
Thanks.

 

[deschutes]

How does rounding on the petri dishes at 5:30am every day including weekends sound? 🙂

~
Well, in preparation of an M4 path elective you will first have to put all your hard-earned knowledge of pharmacology on the shelf.

Ideally you'd like to follow cases through, from gross to sign-out.
You'll probably sit in on sign-outs, and teaching conferences, and if it was a micro unknown you'd take a look at the slides that were set out before and try to ID the tissue and find to your dismay that there really are very few placental pix in Wheaters...
You'd ask some somewhat intelligent questions and draw somewhat intelligent conclusions*, recall some of the basic path principles (how to tell benign vs. malignant, acute vs. chronic inflammation etc.)...
And potentially (depending on how long your elective is) gross in some simple specimens e.g. uterus/lymph nodes/gallbladder.

*(I remember a gross unknown conference I attended - the attending lay a slice of liver out that was violently green. "It's a cucumber!" someone laughed.)

And after 3 interview experiences, I would also add - find an answer to the question "What was the most interesting case you saw on your path electives?"

 

[Weil-Felix]

Don't stress about it, especially not now! You're not even a fourth year yet! The main purpose of an elective rotation is for you to do the following:

1) get a feel for the program and see if it is a place you would like to do residency
2) make some connections with folks in other areas of the country
3) learn a little bit about grossing technique/autopsy/signing out/etc.
4) show the residents/attendings at another institution that you are interested in their program
5) show the residents/attendings at another institution that you are not annoying (very important if you want to go there for residency)

You do NOT have to:
1) prove that you are an expert in any aspect of pathology. No one expects you to know much of anything as a medical student on a path rotation. If you happen to know some stuff, that's a bonus, but don't spend every last minute of your free time studying nothing but histo. Enjoy your fourth year for crying out loud.
2) kiss up gratuitously. If you want to help out, cool. But don't insist on doing everything for everybody, especially if they don't want you to. Don't be that infamous brown-noser.
3) learn everything all in one month. You can't. And that's what residency is for.

Here are the things I did on my electives:
Tried my hand at grossing some small stuff (GI biopsies, appendices, gallbladders, uteri, maybe some other straightforward stuff)
Observed a couple autopsies. Helped out a little with the preliminary notes if the residents were cool with it.
Sat in on signouts at the multi-head scope
Tried to visit different areas of the lab (blood bank, micro, flow, etc) and occasionally visited with the techs about what goes on in their parts of the lab.
Attended conferences


That's about all I can think of. Path rotations are pretty laid back compared to many others that you will do. If you don't stress about it, you might just have fun.

 

[Weil-Felix]

By the way, I wrote that last reply assuming that you were talking about AWAY electives. Now that I read your post again, I guess you were probably talking about home electives. Oh, well. Many of the same things could apply for home electives as well.

 

[yaah]

All good advice. Just be enthusiastic, show up on time, ask appropriate questions (but don't spend the entire signout badgering with questions). THere will always be stuff to do, whether it is attend signouts, review study sets, help residents gross or autopsy, whatever.

You don't need to worry about be able to differentiate between MFH and malignant peripheral nerve sheath tumor. You also don't need to know the Impox staining panel for a GIST. It is a time for you to remember things you learned in histology, start applying them to actual cases. And to see what it is like to be a pathologist and what is important.

Different attendings and residents will approach you differently. Despite having gone through it themselves, some will act as though you should be familiar with the features of sclerosing cholangitis. Others will act as though you can't tell the difference between a neutrophil and a lymphocyte. Just take it in stride, ask questions you have, and try to learn something. People who act interested and seem remotely intelligent tend to get better evals and letters.

 

[DarksideAllstar]

I just wanted to say thanks to everyone for the insight. I do feel a little bit better about not having done a PSF.

 

[deschutes]

I didn't do a PSF either (it wasn't an option!). I don't know however, if that's a pre-requisite for a residency application to UCSF.

Kidding! I really don't know, since I didn't apply there.

 

[DarksideAllstar]

I didn't do a PSF either (it wasn't an option!). I don't know however, if that's a pre-requisite for a residency application to UCSF.

Kidding! I really don't know, since I didn't apply there.

Nothing like a long day with the wackos on psych and then coming to SDN to hear some new up and coming comedians.

 

[yaah]

She'll be here all night, ladies and gentlemen.

 

[DarksideAllstar]

She's got some stiff competition from my female Bipolar patient who traded sex for a peanut butter sandwich. I almost couldn't keep myself from laughing during treatment team.

 

[SpinachPizza]

She's got some stiff competition from my female Bipolar patient who traded sex for a peanut butter sandwich. I almost couldn't keep myself from laughing during treatment team.

What kind of peanut butter was it?

 

[DarksideAllstar]

I think she said it was crunchy, but that just might have been pieces of her teeth coming loose from poor dental care.

 

[yaah]

Mr future UCSF - are you the recipient or the giver of punishment in that avatar? It's always nice to see someone wearing a tie get into a fight. It reminds me of the 19th century when people used to consider a nice fight a social event (even if they were involved) and get dressed up. Those were the good old days. Now you just get attacked and smacked in the back of the head, and when you wake up your money is gone.

 

[deschutes]

It's always nice to see someone wearing a tie get into a fight.

I agree. Hence Colin Firth's charm will never fade.

UCSFbound - are you bound to or bound for UCSF? I thought it was the latter, especially since you are in Vegas - but it's best to be sure 😉

In all seriousness, your patient might not be bipolar. She might be borderline. Bipolar is overdiagnosed in an FP setting partly because the two are difficult to tease apart and partly because it is easier to treat!

I still think it has to be krrrrreeemie peanut butter. So much sexier.

 

[DarksideAllstar]

1. I am neither the giver nor the receiver in my avatar. Its actually a clip from Office Space (when he beats the crap out of the fax machine).
2. My patient is definitely Bipolar. She has had documented mania from previous admits (and which she has now) by the psychiatrists that are currently treating her. She actually does fine once they stabilize her on Depakote-when they d/c her she stops taking the meds. She may have a touch of Borderline (she doesnt meet DSM criteria), but her biggest problem is staying on her mood stabilizers.
3. I am hopefully bound for UCSF. My girlfriend is in the middle of her PhD at Cal, so it would be nice to actually live in the same area as her at some point (since I will be finishing before she does). Plus I love everything about San Francisco (I had the pleasure of living there for a while before I started med school).
4. And yeah, it would have been hotter if 1)it had been creamy peanut butter and 2) if my patient looked like Kate Hudson and not Frankenstein.