Study Question

[lsuhockeyplayer]

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Just a simple question, how do you all study during pathology residency? I think I have been taking a much more ambitious and maybe unrealistic approach to studying.

 

[KCShaw]

We don't need no stinking study!

Everyone's different.. you'll have to figure out what works for you. I tried slowly reading my Rosai cover to cover, but got annoyed that my orderly reading didn't correspond to what I was seeing at work or the lecture series being provided at the time as part of the residency program. So I changed my ways to read about what the program was proactively teaching, as well as selective reading about the cases I was seeing on a day-to-day basis. I did that for most of residency, until towards the end I knew I needed to focus on areas I hadn't seen as much of; by then I was comfortable with most of the bread and butter where I was working, so for the most part didn't need to constantly read up on things I had been seeing regularly for years. By that point I was looking over study materials (Osler, ASCP, Sinard, etc.) as a trigger to occasionally track down more detailed information on certain things.

But, some people feel the need to pick a book or three and read them in order cover to cover. Whatever works, so long as you eventually get through it and can apply it to an unknown slide/case -- and remember the "important" stuff along the way.

 

[lsuhockeyplayer]

First off lets just say I'm a little neurotic. To the point that my current study scheme involves an excel spread sheet mapping out, by the month, what topic I will outline and review. I have this made up pretty much all the way through residency (I'm finishing up my first year).

The problem w/ this current schedule is when work gets busy I dont have the time to get through, what I think I need to get through, each day. Which leads me to get stressed/frustrated.

I'm just really worried that the "study the things you have seen each day approach" will not cover every thing. It just doesn't seem organized to me.

 

[Ombret]

I don't think you need to use a spreadsheet; it won't be worth the effort involved. Your reading and studying will be so much more memorable if you tie them to cases. Or, to put it another way, if this systematic thing is going to work for you based on what you know of your learning style, great, but if not, don't force yourself to do this out of some sense of duty.

Studying what you see will not cover everything, but if you are at a decently big program, it will cover most topics and the gaps will become apparent when you reach boards study time.

 

[lsuhockeyplayer]

don't force yourself to do this out of some sense of duty.

I think this is my mind set right now. Frankly it is burning me out. To the point where my program director showed concern that I look "beat down".

I guess it's just hard for me to believe that just reading about what I see each day could have that big of any impact. I have always had to beat information into my head to get it to sink in.

 

[KCShaw]

I doubt I can help with the neurosis. But for me, it was a lot easier for things to sink in if I saw it as a case, then read about it, all around the same time (within a day or so). If I went off blindly reading about something else I felt I had to work harder for it to sink in, so to speak; for me that largely wasted my time. Though... later in residency it was a lot easier to learn something new because I had developed a good foundation and could draw comparisons to and against things I already knew.

I think there's nothing wrong with keeping loose track of the kinds of things you're seeing &/or reading a lot about, or in comparing those things to some sort of master list (table of contents of one of the major texts, for example) so you also know what you're -not- seeing or reading about -- though that will become obvious enough to most people over time.

Most programs will expose you to what you "need" to know, over the course of 3-4 years. Yeah, you need to "keep up" with reading about those things and a little beyond that, but related -- not just the plain ol' renal cell carcinoma you keep seeing but all of the main primary renal tumors. And yeah, it's smart to set aside some time here and there to read beyond that -- as well as some "you"/relaxation time too. But unless it works for you, I wouldn't spend every waking hour reading about things completely separate from what you're seeing at work -- it's a good way to get confused for one, or burned out for another. Most people worked this out for themselves in medical school, but it takes a little longer for others.

 

[GtownCobra]

Stop being such a gunner, drink some friggin beer, and worry about studying 3 months before boards.

 

[Euchromatin]

I quit trying to take books home to study ancillary topics with around early December last year. Nothing that I read at home unrelated to my cases ever really stuck very well. And trying to force myself to read after dinner while my husband wanted to spend time with me and I wanted to relax was like pulling teeth.

Case-based studying is the way to go - use every opportunity to look at slides and really try to understand what are and are not valid diagnostic features for various entities and what is in the differential diagnosis. I like to study with slides, a book or two open and Pathology Outlines (or similar image bank) up on my computer. I've had better luck occasionally (sometimes frequently 😛) staying late to study up for tumor boards, unknown sessions, or talks I was giving than trying to read up on particular topic at home. I just have found my studying is much more productive and efficient when I have the slides with me to look at (and no distractions).

I agree with KCShaw. It will become obvious once you have been in training for a while what type of specimens or cases you aren't seeing and will need to cover on for boards. I also completely agree that the more you have learned, the easier it becomes to add to that knowledge base. You will become familiar with patterns of tissue injury and inflammation, types of neoplasia, special stains, etc. (oh, this new entity looks just like such-and-such lesion I already learned about in a different organ - gee, these criteria for determining if this carcinoma is invasive are pretty similar to the ones I already know for...)

 

[lsuhockeyplayer]

I guess I used a very organized approach all through college/med school and studying on a case by case basis seems very foreign and unorganized to me. But I've got to try something different b/c I am getting burnt out; I feel it.

 

[Autopsy Sweet]

I guess I used a very organized approach all through college/med school and studying on a case by case basis seems very foreign and unorganized to me. But I've got to try something different b/c I am getting burnt out; I feel it.

I find that trying to stick to a schedule of studying in residency very stressful. I, inevitably, don't meet my own goals, usually due to lack of time and the need to do something other than pathology at night (for sanity's sake).

I can say that something started to click for me at the end of second year and my studying became much more effective as things just started making more sense and sticking around in the brain a little longer. This was very encouraging and makes studying a bit easier now as I don't feel like it's wasted time (the way I did as a first year when none of it seemed to stick).

I agree with the previous posters that a case-based approach is best in the beginning. At some point you will start to discover the areas you are a little lacking in and you can then focus on those topics. I think there's a difference between studying to learn pathology to be good at what you do, and studying for the boards. So, I wouldn't blow off studying until just a few months before the boards as most people wouldn't have the solid foundation they need for their careers (which is different than what is needed for the boards, IMHO).

Try to relax a little with the schedule and feel good about the studying time you put in. It will pay off!

 

[2121115]

Frankly it is burning me out. To the point where my program director showed concern that I look "beat down".

What?!?! Where do you train? Nancyville Community Hospital? At my program the residents looking beat down was a badge of honor to the program director.

LOL. Just messing with you man. Seriously though, I'm glad that your program director cares enough to notice.


Edit: Here is a direct quote from my old residency training program director, "The whole point of residency is to kick your ass and teach you humility."

 

[lsuhockeyplayer]

Edit: Here is a direct quote from my old residency training program director, "The whole point of residency is to kick your ass and teach you humility."

Yea well I've got the humility part. I lack the confidence side of things. I know it's part of residency and all but I feel like I am almost letting my staff down when I screw something up or get a pimp question totally wrong. (I know that sounds ridiculous)

 

[lsuhockeyplayer]

I can say that something started to click for me at the end of second year and my studying became much more effective as things just started making more sense and sticking around in the brain a little longer. This was very encouraging and makes studying a bit easier now as I don't feel like it's wasted time (the way I did as a first year when none of it seemed to stick).

This is actually a good point. I can 100% agree that sometimes I will read something over and over again and still have no clue what I read. Almost to the point that I am thinking I have ADD issues and I need Adderall. I is really frustrating putting in the time and not feeling like you get anything out of it.

 

[lsuhockeyplayer]

I didn't think this deserved another thread:

On the topic of burnout for residents. Have any of you had this and if so how does one come back from it? Vacation, time off cycle, just doing less?

I personally think that doing less would be the way to avoid burn out for longer periods however my mindset (which might be slightly F-ed up) is that if I study and prepare like a crazy person, I can avoid the inevitable "beat down" that comes from screwing up in residency.

I dont know if you guys have any thoughts regarding any of this but I am open.

 

[Pathologee]

I think that encouragement helps a lot. When you get good RISE scores, get an abstract submitted, paper published, go to a meeting, it really re-energizes you. Try to go to a meeting, even a state society of pathology. You will be in a room full of people that want to talk about pathology and you will get good education

I didn't think this deserved another thread:

On the topic of burnout for residents. Have any of you had this and if so how does one come back from it? Vacation, time off cycle, just doing less?

I personally think that doing less would be the way to avoid burn out for longer periods however my mindset (which might be slightly F-ed up) is that if I study and prepare like a crazy person, I can avoid the inevitable "beat down" that comes from screwing up in residency.

I dont know if you guys have any thoughts regarding any of this but I am open.

 

[BurniNation]

One approach that might work for you is to make a checklist out of your reading assignments (if you have already gone to the trouble of making a spreadsheet). That way you can just check things off as you read them, and you don't necessarily have to read in order. You can read around your cases, current didactics, etc and just check those chapters/topics off as you go. When you have extra time or get closer to your boards, you can fill in the things you haven't gotten to. Best of both worlds. I agree wholeheartedly with KCShaw; you will learn much more efficiently reading around real cases, and knowledge will come with much less struggle as you progress through your residency. Good luck!

 

[Autopsy Sweet]

I didn't think this deserved another thread:

On the topic of burnout for residents. Have any of you had this and if so how does one come back from it? Vacation, time off cycle, just doing less?

I personally think that doing less would be the way to avoid burn out for longer periods however my mindset (which might be slightly F-ed up) is that if I study and prepare like a crazy person, I can avoid the inevitable "beat down" that comes from screwing up in residency.

I dont know if you guys have any thoughts regarding any of this but I am open.

I get burned out every June, like clockwork. It helps that, come July 1, there's a whole new crop of 1st years that don't know the answer to anything. I know that sounds sadistic, but it really makes me feel better because I was in those shoes not too long ago and I can see that I've made tremendous progress. I'm hoping that, this being my last year, the countdown from 12 months helps make it go by a little faster.

It also helps to take a few days off, even if it's just to sit around the house and do nothing. It's nice to not think about pathology for a little while.

 

[KCShaw]

I think most people go through a period of exasperation of some sort -- whether it's really burnout or feeling like you're spinning your wheels in terms of learning stuff or boredom or annoyance with attendings or feeling you're ready to take on a -little- more responsibility or..whatever. Perhaps oddly, I really agree that the July intake of new PGY1's always seemed to be a nice reboot -- not only do you get to see how much you know compared to a newbie, your responsibilities may also change, new rotations are on the horizon, and you're another step closer to attending-dom.

 

[Pinglesh]

For all you second/third year residents out there, I am curious as to what kind of baseline level of mastery you feel you have....I feel overwhelmed with learning the ins/outs of approaching a specific organ system, IHC stains, ddx, when truth be told, I can't rattle off the basics from Robbins for example. In fact, I dont think a lot of the 4th years can also, and attendings are going back to Robbins all the time as well. It's frustrating to delve into the details of a specialty organ system path book or even general path book without a solid foundation...solutions?

 

[KCShaw]

Learn a small book well, and don't get bullied into confusing yourself with big books.

Really, I've seen more residents get flustered at the huge volume of material you "have" to learn and end up drowning in it, when at the same time the rare resident figures out you really only need to know a few core things well -- everything else builds off of that. The unfortunate part is that there aren't great, high yield texts addressing that core; you either have to find the right attending or have a knack for pulling out the useful information from the fluff. Most of the high-yield texts are written as review texts, and aren't necessarily geared towards teaching you a thing for the first time. Attendings have a tendency to remind residents that almost no stain is 100% on any one thing, and that a lot of histologic findings can be mimicked or be mimickers of something else, which muddies the waters with zebras for often no good reason (at least for most 1st - 3rd year residents). And students/residents all want to feel like they're ready to plow through a different huge reference text and learn nuances for every organ system when really...they're not.

There are parts of Robbins which are, in fact, fairly useful in practical surgical pathology. There are also parts which are not. When I was preparing for boards, I reviewed primarily by organ system, and in so doing skimmed the relevant Robbins chapter as well as that of a couple of review & question books; the overlapping points that they all addressed generally seemed to be the most important ones, and by repetition also the ones I remembered best.

 

[Gene_]

And students/residents all want to feel like they're ready to plow through a different huge reference text and learn nuances for every organ system when really...they're not.

I have been telling new/young residents this every year. Unfortunately, there is always some 4th year resident around who talks about how much they are learning from reading rosai/silverberg cover to cover in preparation for boards. It just doesn't make sense to read those texts all the way through when you don't have a foundation to build on (which I think is about 2 years of residency). It is not high yield! Junior residents should pay attention in signout/conference, then read about everything they didn't have a good grasp of. If there is time left, read about everything in the differential diagnosis. If you still have time left, you are a faster reader or just plain smarter than I am.

 

[icpshootyz]

First year - learn primarily by osmosis. Double-scope time is where your attendings will feed you key pearls about each diagnosis. Read up on cases as you see them, but not hardcore reading, just learning the important diagnostic facts. I would argue that Boards study materials should be given to 1st years as they have the most high-yield info compared to textbooks. Reading a subspecialty text in your first year is going to be overwhelming. But going through an Osler lecture on a specific subject will take only a little time and hit many key topics. Waiting until you're studying for boards to make use of boards materials is a big mistake.

Then, after you know a little about a lot, start reading more in depth about areas of interest and about cases you see. Then, move on to cases you haven't seen, or that you don't feel like you know very well.

 

[mlw03]

I think the new edition of Sternberg is a very good starting point for each organ system, especially if your program is subspecialty signout. It's not enough to be an expert in that area, but I found it good for being ready for the daily cases on a given service. So to be very specific, if you're on GYN for the fire time, your goal should be to read the chapters on that material during your rotation. Next time through, do it again. If there's a third time, then you can consider moving onto subspecialty book(s) for the tough nuanced stuff (such as borderline versus invasive serous and mucinous ovarian carcinomas).