learning pathology

One challenge facing pathology interns is, well, we have no idea what we're doing. Medical school prepares you to be a clinician -- a general practitioner or a surgeon. Sure, I took a pathology class my second year, but that was more than two years ago, and compared to what a pathologist actually needs to know, that would be like saying an arithmetic class prepared me for upper-level calculus.

(Note: My fellow interns feel the same way; i.e., they possess very little actual pathology knowledge and have a ton to learn. There are certainly some well-prepared interns out there, but they are the exception more than the rule.)

Fortunately, our residency program is cognizant of our neophyte status and has many things in place to get us up to speed:

* We all observed an autopsy our first week here. While that doesn't mean I'm ready to do one myself, it was good to have a general idea of how to approach them.

* Once a week for the first month, we have a "grossing conference" where one of the upper-level residents shows us how to prepare a surgical specimen for microscopic examination. For example, we were shown how to take a kidney, examine it outside the body, cut it into pieces, take appropriate specimens (cancer, margins, etc.), and submit them to be placed on slides.

* Also once a week, there are "normal histology" sessions where we relearn what normal tissue looks like. We learned that first year, which is even more toward the back of my brain, and you can't diagnose the abnormal without recognizing the normal.

* We have occasional lectures on how to survive CP call. This is especially important for those of us who haven't had blood bank/transfusion, since the majority of calls the CP resident receives deals with those issues.

* Every week, there are unknowns that the attendings go over with the residents. As first years, our goal is to describe what the lesions look like. We aren't expected to offer a differential diagnosis until second year, which is good, because I still can't even describe the things properly.

* There are study sets of surgical pathology slides for us to look over. This is mostly interesting cases, but I think some bread-and-butter diagnoses are mixed in as well. In the microbiology lab, there are plenty of study sets, which is about the only way to actually observe the more rare bugs. Other CP rotations probably do something similar to this as well.

* Once a month, we get a test over a particular topic (mediastinal masses, for example), where we have an hour to offer diagnoses on slides and answer fill-in-the-blank questions. All the residents participate in this. It's both comforting and unsettling to see that, while the PGY-1s averaged about a 30 on the one we just took, the PGY-4s averaged about a 70 on the exact same test.

If that sounds like a lot, it is! I feel overwhelmed, not just with how much I need to know to be a great pathologist, but with how much I need to know just not to feel like an idiot at the microscope. It's gonna be a long four years ...