Surg path or forensic path elective as a 3rd year med student?

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CuriousGeorge2

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Hey all,

I am a 3rd year med student and my school scheduled me for elective time before my cores. My school offers a surgical path and a forensic path elective that doesn't require any previous rotation experience. As someone who is probably NOT going to go into pathology (likely going into surgery), are either of these electives worth taking? That is, is there anything that I learn in these electives that I can carry over to the rest of my rotations?

Thanks in advance!

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Good question, and good for you for asking it. If you're going to be a surgeon, I think both forensic path and surg path have value. If it's an option, two weeks of each will serve you well. If you do the FP, focus not just on seeing the "neat" autopsies, but also on learning how to fill out a death certificate, something most physician are absolutely horrible at, but is the daily bread and butter of FP. That said, if you have to choose one or the other, surg path is probably more useful to a future surgeon. Instead of bouncing around, would suggest trying to do 3 weeks of regular signout and 1 of frozen sections. Seeing how frozens are done, their limitations, and their appropriate and inappropriate usage is time very well spent for any future surgeon.

So in summary, you can't go wrong with either elective, but if you have to pick one, surg path is gonna give you more useful knowledge for your future rotations and career. That said, forensic pathologists are definitely cooler (kidding, guys and gals), and you definitely will have a lighter schedule. I've never seen a forensic path rotating med student/resident work past 4pm at any facility I've been a part of - is just the nature of the work.

Hey all,

I am a 3rd year med student and my school scheduled me for elective time before my cores. My school offers a surgical path and a forensic path elective that doesn't require any previous rotation experience. As someone who is probably NOT going to go into pathology (likely going into surgery), are either of these electives worth taking? That is, is there anything that I learn in these electives that I can carry over to the rest of my rotations?

Thanks in advance!
 
Hey all,

I am a 3rd year med student and my school scheduled me for elective time before my cores. My school offers a surgical path and a forensic path elective that doesn't require any previous rotation experience. As someone who is probably NOT going to go into pathology (likely going into surgery), are either of these electives worth taking? That is, is there anything that I learn in these electives that I can carry over to the rest of my rotations?

Thanks in advance!

I see your dilemma. You're not interested in pathology, but every other elective requires that you completed one of the core rotations.

I doubt that any of the day-to-day work you do in a pathology elective will help you too much in your surgery or medicine rotations, but the experience of learning how patients are diagnosed will probably be invaluable, particularly if you're planning on going into surgery.

Autopsy will probably be interesting to relate to your experiences on your medicine rotation, since you'll see first-hand the end results of your patients diseases, but I'm not sure about forensic pathology.

Mlw03, What are the common diagnoses in FP? Various types of trauma?
 
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I see your dilemma. You're not interested in pathology, but every other elective requires that you completed one of the core rotations.

I doubt that any of the day-to-day work you do in a pathology elective will help you too much in your surgery or medicine rotations, but the experience of learning how patients are diagnosed will probably be invaluable, particularly if you're planning on going into surgery.

Autopsy will probably be interesting to relate to your experiences on your medicine rotation, since you'll see first-hand the end results of your patients diseases, but I'm not sure about forensic pathology.

Mlw03, What are the common diagnoses in FP? Various types of trauma?

Depends on the particular office, but yes, various types of trauma, cardiovascular disease, and drug-related deaths are all extremely common in any ME or coroner's office in the US. Any physician would be served by learning a little autopsy pathology, and I repeat my assertion that any surgeon or IM doc would get good experience with how to fill out DCs doing an FP rotation. Every day we see rejected DCs or just poorly filled out ones.
 
Pretty much agree with mlw, as usual for most things FP. I think there's value for any med student or physician in spending a little time in autopsy/forensic path -- and you don't have to like it for it to be valuable. I also quite agree that most physicians are embarassingly and mind numbingly horrible at properly filling out a death certificate and don't seem to realize it or care (so questions don't get asked and people get buried or funerals delayed that shouldn't, with improper documentation upon which millions..possibly billions..of dollars worth of decisions are based), although many forensic offices don't appear to focus much on teaching that as part of their usual elective time (which I wish would change).

As mlw also said, many FP cases are to rule in/out trauma or toxin, or are obviously trauma related, and some are just because an individual has no known history. Heart disease is common, cancer generally is not in that setting (the reverse of what you'll see being delivered to surg path; the patients may have heart disease of course, but not many hearts get removed at surgery). Some offices also handle hospital/non-forensic autopsies. So you can see all kinds of things. Some offices will let you get your hands dirty in actually assisting dissection, but some don't; all should at least let you put some gloves on for most cases, even if you're restricted or can only lay hands on after the pathologist/tech has completed their part.

That said, I also agree that for the average wannabe surgeon, some surg path time is more immediately and regularly relevant and I would give it a slight nod over FP. Again, you don't really have to like it in order to get a lot out of it. If you're up front with your career plans, most pathologists will focus on what you need to know, including what a pathologist can and can't do, what is and isn't appropriate use of frozen section, how long certain things can take or normally take, and so on -- things which will put you in a better position to interact with pathology as a surgical resident -- while also giving you some insight into what a pathologist is actually looking at and may be struggling with or concerned about on any given case.

But you can't really go wrong between the two, IMO.
 
Do surgical path. Spend as much time as possible in the frozen section area- maybe when you're older you won't be yelling at us because it seems like the frozen section is taking forever. ;)
 
I'd have to add my $.02 for SurgPath over Forensics. No insult to the FPs on here, but SurgPath, and knowing the ins and outs of the hospital lab, will be far more useful to someone going into any variety of other medical or surgical fields than a month of forensics. By doing SurgPath you'll gain an understanding of how biopsies and surgical specimens are processed and examined, and you'll likely gain a much better understanding of disease processes. Plus any SurgPath rotation will allow you to observe autopsies as well. Forensics is too focused for you to get that much out of. Plus you won't get any (or at the most you'll get very, very little) histology or lab experience. Do SurgPath.
 
Agree with all the above since these are all great points (especially Tissue issue).

My husband is a surgeon and I've made him watch me do frozen sections from beginning to completion so that he will appreciate what pathologists do. I can only hope that he won't be an *****hole over the intercom or have the nurse call & ask pathology why it's taking so long. Anyhow, after watching a few frozen sections, learning the steps in accessioning/processing/etc, and maybe looking at several interesting cases (grossly and histologically), he will definitely get bored. Everything still looks like liver to him...whatever that means. He's just not that interested. But maybe you are . He would much rather see autopsies or trauma cases (via the M.E.'s office). Does your institution have a busy autopsy service or will you only be seeing a few? Autopsies would be a great tool for you to see the anatomy on a fresh cadaver.
 
Do forensics you might see some freaky **** to impress your nonmedical friends. Besides that is what we do all day in pathology. We work in a lab and do autopsies.
 
Do forensics you might see some freaky **** to impress your nonmedical friends. Besides that is what we do all day in pathology. We work in a lab and do autopsies.

Come on, be nice. Guy comes on to ask a decent question instead of just remaining ignorant about pathology like most clinicians. Let's not be impolite to folks who come in here looking for advice on how to better their knowledge of what pathology is really about.
 
Come on, be nice. Guy comes on to ask a decent question instead of just remaining ignorant about pathology like most clinicians. Let's not be impolite to folks who come in here looking for advice on how to better their knowledge of what pathology is really about.

Second this.

To the OP, it depends on your primary goal. FP is probably more *fun* for a medical student, but gen surg path may be more useful in terms of learning what pathologists do and how pathology will be relevant to your future practice. I definitely agree with everyone who suggested spending some time in the frozen section room, since the questions that you try to answer during an intraoperative consult can be very different from those you're trying to answer during permanent processing. It's also important to spend some time both attending sign out AND accompanying a resident in the grossing room.

I'm going to admit it and say that pathology rotations can be almost mind-numbingly boring for med students, particularly when the students have no responsibility for cases. This is in part just the nature of an observership, which is what most path rotations amount to, and because of the vastly different nature of pathology in comparison to clinical work. If you find histology exciting, then by all means read up a little about specific disease entities. To be honest, however, there's very little you can do in a single month in terms of becoming totally comfortable with histology, and it is not something you should really focus on in order to prepare yourself for your future. I think the most important thing for you would be to get a general idea of what pathology is and how it works, from practical things like specimen processing to the fact that individual interpretation and opinion plays a big role in diagnostic pathology. Pathology rotations in many academic centers are quite poorly organized - students can easily rotate through for a month and still have absolutely no idea what pathologists do.

Find a couple of residents who are into teaching, and have them show you around the cutting room, frozen room, and histology areas. Have them explain how specimens get processed, from beginning to end. Spend some time with the autopsy residents that month - often, a one month gen surg path rotation still allows you time to spend observing/helping with medical autopsies. Find out who the chief resident is, and have them help you figure out who to talk to/shadow/work with during the month. Engage the residents and attendings and have them explain to you how we approach a specimen and what we do to answer the questions that the clinician has. Learn that we need to communicate and form a functional professional relationship in order to do what's best for our patients (clinicians often forget that these our patients, too, and we care about providing the best care that we can - the idea that we're "lazy" or reluctant to work and advocate for our patients is ridiculous in most cases; while there are a few people who just don't care, most of us do!).

Don't forget to have fun - anything can be fun and educational if you approach it with an open mind.
 
do surg path. that way you will understand that a pathologist cannot make chicken soup out of chicken s***.
 
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