Subspecialty Books for Young General Pathologists

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Feb 5, 2021
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Very brief background: I am a general pathologist in his first year as a full-fledged attending, following a standard anatomic/clinical residency, a fellowship in renal pathology, and a fellowship in genitourinary pathology. I'm working in a busy academic practice with general sign-out, so I'm seeing a fair amount of everything. I've been showing a lot of cases to more experienced attendings and trying to learn what I can that way, but I'd also like to be proactive about patching areas I'm less experienced in with reading. So I'm really looking for two categories of books: books that are effective at *teaching* a given subspecialty and books that are effective *references*. In my experience, it's rare that a book can serve both purposes effectively so I'm willing to double up. The subspecialty areas I think I most immediately need to develop are gyn, pulmonary (we see a fair number of transbronchial biopsies), breast, and GI. Eventually, I'd also like to get to other areas but head and neck volume has (thus far) been less significant and derm and bone/soft tissue are larger projects. I would really appreciate any recommendations. During residency, I relied on the standard general surg path tomes for an overview and whatever references were at hand in our resident library for answering particular questions, but I find now that my name is actually on the bottom line I've become more discriminating and I want to approach things more deliberately moving forward.

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This exemplifies one of the problems with our field. The areas he describes as being problematic are bread-and-butter surgical pathology. Now, this bright young guy/gal has just done SIX years of looking thru a scope and learning
,hopefully. And, the time he spent doing two fellowships seems to have HURT him becoming an excellent pathologist
in most situations. Might do fine if it was all renal or whatever, but..........
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I assume you're hoping to focus more on renal/GU subspecialty exclusively at some point?

IMO books are great references (whether they're intended for "teaching" or "reference), but if you didn't retain it while reading it >2 yrs ago, it's not going to magically stick now. Reading Rosen front to back will undoubtedly "teach" you a few things about breast pathology, but it's not going to tell you how to handle specific cases. Seeing real cases is what sticks.

Gyn, lung, breast, GI, H&N, derm/soft tissue are massive's like everything outside the purvey of renal/GU--not sure how to advise the best approach to "learning" something in those areas as opposed to "brushing up" on tricky areas, which can be done with any number of books. And regardless there will still be things you're never totally comfortable signout out due to their infrequent nature. If your department is a good one, they'll see your value in providing medical kidney (are you the only one doing this?) and GU expertise and not be perturbed by the general sign out QC (within reason).
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I'm personally a fan of the AFIP atlases. They just started their 5th series and it will encompass both neoplastic and non-neoplastic pathologies.
Perhaps my background was a bit *too* brief. In residency, I saw a fair amount of the bread-and-butter GI, gyn, and breast cases. But I certainly didn't reach the level I would have had I done a fellowship in those areas and after completing my GU fellowship I am acutely aware of the difference between a graduating surg path resident's knowledge and a fellow's knowledge. I don't expect to be able to fully bridge that gap but I want to do right by my patients. I want them to get the most accurate diagnosis they possibly can so what I would *like* to do is to identify some approach that will bring me as close to the knowledge base of a subspecialty-trained fellow as I reasonably can. I think my patients deserve that. One approach would be to just sit down and read one of the giant reference tomes of the subspecialty and hope things stick. The trouble with that approach is that I've found most of those tomes to be relatively ineffective at actually conveying information unless one knows all-but-this-one-little-detail about a subject. They're not designed as teaching resources; they're references, mainly intended to comprehensively supplement the knowledge one already has. Perhaps some of the giant tomes are written differently--but I can tell you right off that if you sat down and read Heptinstall's cover to cover it would be a terrible way to learn renal pathology. There are other books I would suggest for that before you dive into Heptinstall's. So that's what I'm looking for: what books in each subspecialty should I *start* with to set myself on a path to ultimately becoming a sort of pseudo-subspecialist.
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I'm about 2.5 years into attendinghood and I'll echo the comments about real cases. Even in residency/fellowship I've never found books to be nearly as helpful as learning through practice and using books to help with a specific case or specific question. Reference texts are great to have and fairly comprehensive, but I most often use three websites for daily sign-out: Pathoutlines, Librepathology, or Expertpath.

But by far the best resource is an experienced and competent colleague who won't judge you for showing stuff that you worry will make you look stupid. I was extremely lucky to have someone like that for the first year plus and it was a huge help in transitioning to the start of my career. RIP
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I'm a PGY-1 newbie but I think the Biopsy Interpretation series are really great esp for breast pathology.
I've been practicing for about 3 years in relatively busy academic practice (after completing a neuropathology fellowship). I mostly sign out general pathology and cytology. Showing cases to a couple of experienced mentor-like pathologists is helpful. Reading through old reports in the system on certain biopsies/specimens can give you a feel of how things have been signed out at your practice (don't copy/paste, obviously). I also think the biopsy interpretation books are good resources for the areas you described above in terms of tricky cases and plugging gaps. In the end, it'll come down to looking at and signing out more cases, period.
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