Starting pathology (entire handbook): Difference between revisions
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''Author: [[User:Mikael Häggström|Mikael Häggström]]'' | |||
==Using this handbook== | |||
The goal of this handbook is to make a new pathology trainee able to properly handle at least 80% of cases that are expected at an average general pathology department, including the exclusion of the most pertinent differential diagnoses thereof. | |||
It is recommended to scroll quickly through this handbook to get an idea of its content, and then keeping it at a known location for whenever information is needed for a corresponding patient case. It is not recommended to memorize its content indiscriminately. Other doctors and even laypersons can look up diseases and conditions themselves, including pathology characteristics, without the need for a pathologist consultation, so the expertise of memorizing such readily available information is expendable. In a world where diseases and conditions can readily be '''looked up''', a major skill that distinguishes a pathologist from any person with Internet access is mainly the ability to identify and put '''words''' to findings on microscopy or other non-written results. Another major skill is to be able to deal with '''unusual or equivocal''' presentations. Unusual or equivocal presentations of very common diseases and conditions are still generally more common than rare diseases, and constitutes a major workload in everyday pathology practice. However, most textbooks still give disproportionately large room for rare diseases compared to such presentations. Nevertheless, strive to '''master the common''' conditions (including the most common pitfalls) before diving into the uncommon. Specialists and subspecialists may already have learned the common conditions, at least in their subspecialty, and they will often distract you from this pursuit by presenting rare conditions to you, because that is interesting to ''them'', but do not spend excessive time or mental effort on such rare conditions during your first years. | |||
===What a pathologist needs to memorize=== | ===What a pathologist needs to memorize=== | ||
The best method for memorization is generally through repeated exposure in everyday practice, but the following things are most important for a pathologist to focus on memorizing: | |||
* '''Emergent pathology''', mostly relating to intraoperative or frozen section consultations. This includes information that usually cannot be timely looked up on the Internet when needed. | * '''Emergent pathology''', mostly relating to intraoperative or frozen section consultations. This includes information that usually cannot be timely looked up on the Internet when needed. | ||
* Main '''pitfalls''': Most common and dangerous situations where a pathologist may not recognize the need to look something up further or ask a senior colleague. | * Main '''pitfalls''': Most common and dangerous situations where a pathologist may not recognize the need to look something up further or ask a senior colleague. | ||
* '''Patterns''' and '''signs''' which can be seen grossly or under the microscope. It confers the ability to translate visuals into words that can be looked up if needed. | * '''Patterns''' and '''signs''' which can be seen grossly or under the microscope. It confers the ability to translate visuals into words that can be looked up if needed. | ||
* Knowledge of '''where to find information''' for various situations. It includes which person or which '''search engine''' is most useful for various clinical situations. Google is generally an appropriate search engine, but sometimes more specific or comprehensive databases are necessary, such as for example ClinVar to look up the pathogenicity of specific genetic variants. | * Knowledge of '''where to find information''' for various situations. It includes which person or which '''search engine''' is most useful for various clinical situations. Google is generally an appropriate search engine, but sometimes more specific or comprehensive databases are necessary, such as for example ClinVar to look up the pathogenicity of specific genetic variants. The chapter will include a '''directory''' of major databases and external guidelines. | ||
* Proficiency in diagnosing '''equivocal or borderline cases''' where readily available sources and evidence usually deal with discrete and specific disease entities and subcategories thereof. Thus, in the question sections, many questions will be in the format of displaying readily available facts about diseases, including their typical immunohistochemistry patterns, but with equivocal or borderline case presentations. | * Proficiency in diagnosing '''equivocal or borderline cases''' where readily available sources and evidence usually deal with discrete and specific disease entities and subcategories thereof. Thus, in the question sections, many questions will be in the format of displaying readily available facts about diseases, including their typical immunohistochemistry patterns, but with equivocal or borderline case presentations. | ||
* Having an idea of one’s '''unknowns'''; being aware of unfamiliar fields. For example, a pathologist generally does not need in depth knowledge about cases that are generally sent out to specialized centers (such as pediatric musculoskeletal oncology), as long as that pathologist is aware of lack of knowledge in that field. | * Having an idea of one’s '''unknowns'''; being aware of unfamiliar fields. For example, a pathologist generally does not need in depth knowledge about cases that are generally sent out to specialized centers (such as pediatric musculoskeletal oncology), as long as that pathologist is aware of lack of knowledge in that field. | ||
[[File:What you need to memorize.jpg|350px|right]] | [[File:What you need to memorize.jpg|350px|right]] | ||
* '''Dealing with Internet denialists and their exams.''' With the ease of access to pathology information on the Internet through smartphones and computers, those studying to for everyday practice as a pathologists '''should not''' spend time memorizing what can essentially always be conveniently and timely be looked up in times of need. The topics listed above are already immense enough to cover a lifetime of learning. Nevertheless, the path to pathology certification includes one or more exams, whose questions are largely made up of people who still do not acknowledge the access to the Internet in everyday pathology practice, and therefore this curriculum also includes this chapter. | * '''Dealing with Internet denialists and their exams.''' With the ease of access to pathology information on the Internet through smartphones and computers, those studying to for everyday practice as a pathologists '''should not''' spend time memorizing what can essentially always be conveniently and timely be looked up in times of need. The topics listed above are already immense enough to cover a lifetime of learning. Nevertheless, the path to pathology certification includes one or more exams, whose questions are largely made up of people who still do not acknowledge the access to the Internet in everyday pathology practice, and therefore this curriculum also includes this chapter. | ||
== | ==Emergent pathology== | ||
'''Surprise frozen sections''' | '''Surprise frozen sections''' | ||