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Starting pathology (entire handbook)

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''Author: [[User:Mikael Häggström|Mikael Häggström]]''
==Using this handbookLearning pathology==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 {{Learning 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, and to conceive most likely diagnoses based on both verbalizable and more abstract appearances. 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. This handbook is therefore written with the intention to teach you what to do in various situations you are expected to encounter during your first years of pathology training, at least until the point that you are usually fairly confident about what disease or condition you have at hand, because then you know what words to use to look it up in the vast literature out there. ===What a pathologist needs to memorize===entire article}}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.* 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.* 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 {{General 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.* 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]]* '''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. This includes most of the content of books that are sorted by titles of diseases and conditions, because if the name of a disease is already known, it can relatively quickly be looked up when needed. 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 resource also includes a chapter on dealing with Internet denialists and their exams.- entire article}}
==Emergent pathology==
 
'''Surprise frozen sections'''
Although these are generally given on schedules of the operating room, any pathologist may end up suddenly covering for another one, and subsequently be presented with the frozen section case without having had the time to look it up beforehand.
 
==Non-emergent pathology==
 
Also largely a directory of external guidelines and databases.
 
'''Non-emergent pathology questions'''
 
FINDING GUIDELINES
 
Which of the following situations does not have comprehensive guidelines available online?
 
INFECTIOUS DISEASES
 
Ask what are the main locations to look for infection in a specific autopsy case.
 
Provide algorithm of gram stain etc. and table of main bacteria by various locations.
 
'''Where to find information'''
 
INFORMATICS QUESTION
 
Provide genetic variant in long format.
 
- Which database is the best to use to look up the pathogenicity of this variant?
 
 - ClinVar (correct)
 
 - gnomAD (population frequencies)
 
 - PolyPhen (likelihood of protein damaging)
 
 - PharmGKP (associated treatments)
 
- In ClinVar, what would you enter
 
 - A1708V (then BRCA1)
 
===Dealing with Internet denialists and their exams===
An Internet denialist probably knows about the existence of the Internet, but keeps acting and teaching as if being oblivious of it. An Internet denialist generally takes '''pride''' in for example memorizing the chromosome locations of even rare mutations, but when being called in for a frozen section of even relatively common specimens such as brain, lung or skin tissues, they may not know how to differentiate even the most common 90% of diagnoses.
 
An Internet denialist who has memorized something may '''assume''' that pathology trainees should memorize it as well, and entire lectures may largely consist of rants of such items. In reality, when something is encountered and looked up something enough times, it will generally get memorized, and it is generally more efficient to let time tell which situations will be common versus uncommon, rather than trying to memorize knowledge that may never be needed.
 
Also, while you should initially focus on learning the most common conditions, specialists and subspecialists may already have learned the common conditions, at least in their subspecialty, and they will often distract you from your 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 at least your first years.
 
An Internet denialist '''exam''' is basically any exam wherein the examiner does not have access to the Internet, and typically is not allowed to ask colleagues either, even for non-emergent topics that can conveniently and timely be handled by such resources. Since the Internet and teamwork are fundamental parts of everyday practice, such exams are thereby of a different dimension.
 
====Exam studying====
Since exams and everyday practice are generally very different (as per previous section), you should generally study specifically for an exam or study specifically for solving each case you encounter everyday, rather than trying to study any material with the intention of covering both purposes. After all, for a multiple choice exam like the American boards, you don't actually need to '''know''' the answer, but just have a feeling of what is the '''most likely''' answer among the choices. Also, you will become proficient at what you do: If you read textbooks you will be more proficient at reading textbooks, if you study to solve everyday cases on your table then you will become good at that, whereas the best way of becoming more proficient at multiple choice exams like the American boards is to practice qbanks with a similar multiple choice format. There are multiple ones for the American boards (PathPrimer, PathDojo, BoardVitals, ASCP Resident Q bank), and you should exhaust them and repeat at least the ones you failed the first time, before continuing with other study materials. For highest yield, don't read every explanation for every answer, but just the answers that contradicted your belief, just enough to learn why it wasn't what you initially thought. Also, you don't have to memorize every clue to the right answer, but rather get an idea of what makes the right choice most likely, because that's basically all you need to choose that right answer if it would appear in the actual exam. To check if you got it, you may for example review the correct answers for a test until you almost immediately find them to be reasonable, and repeat the question later if you have the time. If the Qbank shows the average percentage of test takers who got a question right, put somewhat less effort on questions with very low percentage, since you generally have less of an expectation of knowing those.
=Fixation=

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