Changes

Jump to navigation Jump to search

Starting pathology (entire handbook)

10,883 bytes removed, 18:59, 18 November 2021
m
Format
''Author: [[User:Mikael Häggström|Mikael Häggström]]''
==Learning pathology==
The goal of this handbook is to make a new {{Learning 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, 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.entire article}} ===What a pathologist needs to memorize===The best method for memorization is generally through repeated exposure in everyday practice, and the scope thereof will depend on your eventual location and subspecialty, and you will eventually forget everything else, more or less. Yet, the following things are most important for a pathologist trainee 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]]* '''How to deal 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 act as if they were Internet denialists; as if they do not acknowledge the access to the Internet in everyday pathology practice. Therefore, this resource also includes a chapter on dealing with Internet denialists and their exams. ===Using resources===This resource is 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. At that point, the fastest way to get more information is generally by Googling the disease or condition name, followed by ''pathology'' or ''pathology outlines''. If you just want to see more micrographs of the disease or condition, the fastest way is generally to Google the condition and then clicking the Images tab. Specific searches for specific purposes include:*Adding '''cancer.net staging''' in Google searches for definitions of cancer stages, for example Googling ''prostate cancer cancer.net staging''. The first search will then generally be the one from the American Society of Clinical Oncology.*Considering a subscription for '''ImmunoQuery''' rather than trying to memorize all immunohistochemistry markers for all conditions. '''Ask a colleague''' at least whenever your own memory or a resource search is not enough, and there is a significant risk that you will do something irreversible that will negatively affect a patient. ===Dealing with Internet denialists and their exams===An Internet denialist probably knows about the existence of the Internet, but keeps teaching as if it didn't. An Internet denialist generally takes '''pride''' in memorizing even facts that can presumably always be looked up in time of need, and often even practically useless information such as most chromosome numbers of mutations. The main problem is that when Internet denialist has memorized something, he or she often assumes that pathology trainees should memorize it as well, and will waste time and effort from the pathology trainee on such memorization. In reality, when something is encountered and looked up something enough times, it will generally get memorized, and apart from the necessary items listed in the previous sections, 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. Yet, as a trainee, the best '''approach''' is generally to not defy the instructions of seniors, even if they seem like a waste of time, but possibly politely question if it is necessary. Also, never call a senior an Internet denialist as name calling is generally regarded as unprofessional. Yet, you may spend the minimal time and effort on such tasks in order to spend more time with your patients at hand, or learn things that are necessary to memorize. 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 compared to reality. ====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 preferably go through all of them and then repeat at least the questions you failed the first time, before continuing with other types of 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 and every detail of 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. For example, for a picture of a hairy cell and a question about mutations, you probably only need to associate it with for example "barf 600 something", rather than knowing that suspected hairy cell leukemia is confirmed by genetic testing for the BRAF V600E mutation. To check if you have remembered a question sufficiently, you may for example review the correct answers for a test until you almost immediately find them to be reasonable rather than unfamiliar, 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. Efficient exam studying will allow you more time, effort and brain space to memorize what you actually need, as well as to perform for example studying for solving your actual everyday pathology cases as per sections above.entire article}}
==Emergent pathology==
 
'''Surprise frozen sections'''

Navigation menu