Tips and Resources for Pathology Sub-Is? (2024 Update)

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Aug 9, 2022
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Opening this up again since the latest thread on this hasn't been posted since 2011 and I wanted this as a future reference for other students. I'm doing one month of general pathology (mostly surgical), followed by one month of hemepath, and then a lighter elective in forensic path before I start an away at my preferred institution and wanted some guidance on how to shine as a 4th year student.

I'm primarily having trouble finding tips and resources on performing grossing and sign-outs, particularly as a student.

If you all have any tips, please let me know and I can add them to this post and help out other potential path students:

1) Be normal, helpful, and interested. They don't expect you to know everything.
2) Don't be weird.
3) Find a helpful mentor resident or attending interested in teaching.
3.5) Also seek help from the histo-techs and PAs.
4) If no other tasks, show up to all the conferences/tumor boards/grand rounds.
5) Preview slides with resident before sign-out.
6) Presentations - Choose an interesting case if a presentation is required.
7) Have a foundational understanding of how samples are obtained and how tests (FISH, PCR, Flow-cytometry, ELISA, etc.) are performed.

Resources I've found, please feel free to critique or add more:

(Most recommended)
Molavi Surgical Pathology Textbook

Kurt's notes: Kurt's Notes – By Dr. Kurt Schaberg

Hopkins Cyto: Johns Hopkins Cytopathology Unknown Conference

Path Outlines:

Blood Banking: Blood Bank Guy - Essential Transfusion Medicine with Joe Chaffin MD

Histology Guide: Histology Guide - virtual microscopy laboratory

Shotgun Histology: YouTube Playlist

PathElective: Their site is very broken and most aspects that would be useful are "under construction" for the past two years.

Match2Path (Application help): General 2 — Match to Path

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The #1 thing is to show a sincere interest in learning pathology. If you are sincerely interested in pathology, then you can shine naturally.

No one will expect anything knowledge related in regards to pathology. Maybe histo since we all took histo first year in med school but I doubt any attending would hold it against you if you didnt know histo. The best med students and junior residents are the ones who sincerely enjoy pathology and they are easy to get along with and are not weird/crazy or aholes. They are eager to learn without being annoying or obtrusive.

That being said, just because an attending does not expect anything from you, it doesnt mean you just slack off and dont even put in an effort to preview slides even though you dont even know what you are looking at. Showing an effort on your part will go a long ways with an attending. Showing enthusiasm to learn will give you bonus points. If you have a question during signout, ask but dont be annoying. If you are naturally inquisitive about learning pathology it will show.

Ive been told by academic friends that some first year residents dont even show interest in previewing their cases.

In regards to grossing you just learn as you go. The best way to learn grossing is to be next to the resident or a pathology assistant while he or she grosses. Know the concept of margins and taking the appropriate sections that will allow you to fill out the synoptic report in cancer cases. You just got to observe someone gross. No need to read beforehand. You probably wouldnt get much out of reading until you actually SEE the physical gross specimen.

Go to signouts and dont get in the way of the resident. Learn as much as possible. Use pathologyoutlines and Molavi when reading around your cases.

Attendings are basically looking for people who have a sincere interest in pathology, who is hard working, pleasant and who won't present a problem in their program.
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Doing a pathology rotation as an interested medical student is necessary but difficult. You can't do actual patient care like grossing or writing reports like in clinical medicine. And previewing "live" cases will probably be very limited because that's blocking a resident or attending from looking at them. Most likely you'll be sitting at a double-headed scope while someone else drives and describes what they see or pimps you on what you think for an hour or two. The rest of the time you might be given some slide sets and an old, barely maintained microscope from the 70s for self-study. Or given to the lab staff for them to show you how the lab runs, but isn't really day-to-day pathology work. Throw in some conferences or tumor boards and that's your rotation.

It's terribly boring and despite being in the same environment is not the same experience the residents and attendings are having because you're not able to do actual work and make real decisions. Lots of people work in an academic setting that either don't like teaching or aren't good at it, and because of the above you're slowing everyone down. Most people understand how this is, so try to find those few people that do want to teach you something. Read Molavi so you can ask decent questions or offer a very simple differential. Ask if there's anything to do or any way you can help. Someone might let you practice cutting frozen sections on a placenta or run slides through the stain line.

Above all, specifically mention that you're interested in pathology and why. You'll be treated differently from another student who just wants an easy rotation.
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Not to disallusion you, but neither residents or fellows(even if boarded) can sign out a vas deferens today because of fiscal meddling by the government. Back in the day, senior residents in their final month(s) of surg path signed out independently (at my institution). You were expected to consult appropriately. Not surprising that the transition to the “real world” today is difficult for many.
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Not to disallusion you, but neither residents or fellows(even if boarded) can sign out a vas deferens today because of fiscal meddling by the government. Back in the day, senior residents in their final month(s) of surg path signed out independently (at my institution). You were expected to consult appropriately. Not surprising that the transition to the “real world” today is difficult for many.
We don't fully sign out to residents or attendings, but we are expected to understand the process and essentially "play pretend" with sign outs using practice slides with features that can be seen/identified at the student level (Ex: Identify obvious Auer Rods/AML on a Wright Giemsa stained tissue). Obviously would not sign out a real patient.
I think if you speak fluent English you've already met expectations.
If you know the different layers of the skin you are functioning at PGY2.
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All med students interested in pathology should rank programs with strong hands on teaching in both AP (preferably surgical volume of at least 30,000) and CP. Most programs Ive been to had subpar CP training. Look for programs that have a lot of hands on practical experience during rotations in CP. Not just a bunch of boring, read off your slide lectures given by attendings. You want to be in program with strong expertise and good teachers and people who care. Not many programs are strong in CP. Most are mediocre.

I went to a program with poor CP training and Id hate to see anyone go through the training I did. My program actually went on probation from what I heard after I left there years ago.

Also make sure you dont go to programs where you will just be someone's b$tch and you are actually learning througout your 4 years. Some programs are so busy or even worse undermanned and resident education suffers because of that. OR you have some antisocial pathologist whos in academia who doesnt like to teach (basically a private practice pathologist type who can only signout one or two subspecialties who isnt academic material). They dont teach or enjoy dealing with residents who are there to learn.

I found unknown conferences (5-10 slides each conference) in AP every week or every other week led by attendings to be very helpful for boards.

Just some advice....
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