What subject had the steepest initial leaning curve for you in residency? How did you handle it?

[Mark20192916]

py1 entering py2, need some insight

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[Unsatisfactory]

I thought it was all hard for a year or 2, then the lights slowly turned on for the last 3.. Now its going the other direction. I can never remember the words Molluscum contagiosum, never never.

 

[SunBakedTrash]

It's all a matter of experience and practice. Push lots of glass, read up on your cases and treat everything you see like you might use it someday, Might even save you a fellowship (or two).

 

[Alteran]

You'll get good at whatever you see a lot of. The areas of pathology that an individual pathologist struggles with are primarily based on lack of exposure and quality of faculty overseeing said area. That's why its important to go to a good residency program that has a wide breadth of specimens and decent faculty who actually impart their expertise.

 

[LADoc00]

dunno if you sit and just read, pathology always seemed super easy to me (and now it is not even remotely intellectually challenging). If you dont read of course its like to trying to converse in English with someone who knows only Greek. Its binary, either you do the reading and know the answer or screw off and just flounder expecting people to hand feed you the info. I actually think you could theoretically train someone to be top notch pathologist in a year with enough intensity and focus.

The area that most trainees struggle with is procedures, mainly because they get such little practice. So marrows, FNAs etc.

I dont believe faculty in training make any difference from an intellectual standpoint and predominately affect a trainee's practice mindset: if youre faculty are weak, you will be weak, if they are strong, then you will tend to be strong etc. You will get out of training what you personally put in. It could be East Virginia Medical Center or Harvard's Brigham and Women's, doesnt matter.


There is plenty of "material" to learn from at almost any hospital to become a competent pathologist. I had a very bright AND wise chief resident once tell me that.

 

[KeratinPearls]

dunno if you sit and just read, pathology always seemed super easy to me (and now it is not even remotely intellectually challenging). If you dont read of course its like to trying to converse in English with someone who knows only Greek. Its binary, either you do the reading and know the answer or screw off and just flounder expecting people to hand feed you the info. I actually think you could theoretically train someone to be top notch pathologist in a year with enough intensity and focus.

The area that most trainees struggle with is procedures, mainly because they get such little practice. So marrows, FNAs etc.

I dont believe faculty in training make any difference from an intellectual standpoint and predominately affect a trainee's practice mindset: if youre faculty are weak, you will be weak, if they are strong, then you will tend to be strong etc. You will get out of training what you personally put in. It could be East Virginia Medical Center or Harvard's Brigham and Women's, doesnt matter.


There is plenty of "material" to learn from at almost any hospital to become a competent pathologist. I had a very bright AND wise chief resident once tell me that.

I think being in a busy residency helps versus just being a residency where you see a few cases a day then sit around. I mean the same thing can be said of cardiovascular surgery. The well trained folks are the ones who come from busy institutions that do a lot and have a lot of hands on experience. Doesn’t have to be Brigham but any place that is busy and you have hands on experience will do. You hear the surgeons brag how many cases they performed. “I did 1000 aortic valve replacements and x heart transplants last year!” There’s a reason why they brag because it shows they have a lot of experience handling complex cases versus someone that has only done a handful.

Trainees become better in a busy environment doing more than in a hospital where you just see a few cases a day or less complex cases. I mean you can just look at cases on your own but for someone who is just beginning or learning I don’t think you’d want to be in an environment like that.

I agree you get whatever you put in but I think To become good as a beginner you need to see a lot and handle a lot of cases on your own, make mistakes, get feedback from attendings in regards to those mistakes and learn from it. That’s how you become good by continuous repetition and active learning, not just sitting and looking at cases on your own because your program may not be busy.

I recommend any medical student to go to a busy residency or fellowship.

 

[LADoc00]

I think being "busy" at a high volume training center helps manual dexterity and muscle memory but I am not so sure about cognitive bench marking.

I agree with you in a sense you could, theoretically get high value scope training at a super high volume place, but you could also theoretically get much worse training there as well.

Hear me out: if you step up to the training tempo and read/study, "burn the midnight oil" etc then it could work. If this is paired with dual positive AND negative training reinforcement aka praise when you do well as well as brutal criticism when you screw up, then you could again theoretically benefit. But I have seen it miserably fail for an unacceptably high number of trainees.

But I often hypothesized that a Goldilocks training paradigm was the best: one in which your days were filled up but not too much, leaving you time to unwind, rest and most importantly read. I moved from rotation to rotation and found it the best in fellowship (which perhaps was due to just 2 less hours a day doing scut work that converted to 20 more hours week being able to focus and read with less exhaustion). I think I reread every surgical path text in my fellowship + about another 15+ more texts and hundreds of articles (I made a simple goal of 2 articles/day, everyday, without fail for 1 year).

I designed my own training program in my last month of fellowship as a mental exercise. Even created a 40+ page manual (which I lost when the computer I was working on melted down). Because I had so much SO experience by the end of it at so many different places (West, Midwest and East coast) I had distilled what I thought were the highest value exercises at each individual stage of post grad education. You would be surprised at the interesting innovative tricks small sleepy programs come up with the train people that would be brilliant integrated into a larger program.

 

[ScubaV]

Certainly people's learning styles are different, but to me reading will develop your mental repertoire of diagnostic entities, but won't improve your skills as a diagnostician. That comes from practice with actual cases. A book or journal article can outline a bunch of criteria that you'll probably forget or show you pictures of the diagnostic field (if they're not crappy). But to find that diagnostic field, or judge a grey area or criteria that don't neatly fall into place needs practice and lots of it. That said, you can't diagnose what you don't know and trying to look up entities in some reference is harder when you're not sure what to look for.

As for the question, most of CP was tedious because there was almost zero hands on training. It was all self-taught by reading, mostly memorizing in preparation for boards.

In AP, I hated derm because every entity has like three different names using a combination of descriptors, Latin, and eponyms. Also, we had a dermpath guy who was really good, but you only saw those cases if you rotated with him or from one of his sporadic lectures, so there was no reinforcement of the learning and the practical knowledge faded quickly. I also disliked heme because cases took forever to sign out and often required multiple ancillary tests that added to the delay.

The solution is to just power through as best you can and pick a couple areas you enjoy, or at least don't mind. You want your general knowledge to be as solid as possible, but today's healthcare environment of consolidation and increased specialization means you'll probably have someone to show stuff that you're weaker in. On the flip side, you then need to develop other skills so they can reciprocate.

 

[deleted314957]

Derm’s not so bad. A handful of neoplasms that account for 98% of lumps, bumps and excrescences, and everything else is “ chronic dermatitis.”


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[Mark20192916]

At this stage (end of year 1), I still often find myself clueless, and I don’t seem to retain much of what I read. I don’t want to entertain the thought of failing, but really worried to say the least.

 

[deleted642280]

At this stage (end of year 1), I still often find myself clueless, and I don’t seem to retain much of what I read. I don’t want to entertain the thought of failing, but really worried to say the least.

I didn't stop feeling like that until after year 2, maybe partway through year 3. It's a whole new language and was really difficult for me particularly coming from a non-basic science background. I came from clincial care as a career change so everything was completely foreign. It felt for a while like I would never learn it, but I surprised myself in the end. Hang in there. For me, the most important thing was finding mentors I could talk honestly with and get advice from. Some of my "meanest" teachers I was scared of in PGY1 turned out to be my now closest mentors I learned the most from and really like now.