All I Really Need to Know I Learned in Residency

If you are old as I am (I was a non-traditional medical student), then you might remember a book called All I Really Need to Know I Learned in Kindergarten that remained on the NYT Bestseller List for an impressive two years back in the 80s. It was full of aphorisms of how a simpler perspective might prove to be a better and/or happier way to live. So, I’ve been wondering all week while frantically trying to get my USCAP poster done before the rush fee deadline goes into effect (I guess I never learn)…do we really learn everything we need to know to be good pathologists during residency?

Training programs are variable – some make you work for it while others, not so much. But in the end, the day after graduation, we are all expected to be full-fledged competent pathologists…as if, in those magical 24 hours, we have all become smarter, have mastered our inefficiencies and time management issues, and are suddenly better than we were a short time before.  But honestly, since you probably spent that last day not in pathology mode, the only thing that we can be sure of is that you are 24 hours older. Despite the differences in our training, the majority of us will go on to pass our boards, and scary thought, practice the day after we graduate (although that might mean postponement until after fellowship).

Residents are also variable in terms of how and what they learn. I admit that I never expect to be the best at surgpath, especially grossing. But I do keep trying and hope that I don’t hurt patients in the process. I hope to at least survive until I’m done with surgpath for good. And I know regardless, it will still help me whether I decide to go into molecular pathology or hematopathology or a combination of both. I do know that I excel on my most of my CP rotations. But what do we need to do to learn and improve on our deficiencies and move past our comfort zones? For me, I’m comfortable in the lab since I went to graduate school, originally was a dual degree medical student, and had a decade of research experience prior to medical school but I’d love to hear advice and stories of how residents improved their grossing skills and surgpath differentials or finally triumphed over that weakness or deficiency that kept showing up on your evaluations.

Despite where we train (even at the best programs), I’ll bet that most of us in our initial years will need to know the following, but not in any particular order:

  1. When in doubt or you don’t know, ask for help from someone you trust and respect
  2. The printed word…whether journals, textbooks, or Google…is your friend, so use it, and use it often
  3. Sticky notes or checklists really do help keep us organized
  4. There is never enough time in the day so plan and use it wisely
  5. Getting angry (at ourselves or others) really won’t help so re-direct that energy towards something positive
  6. You are never too old to learn something new
  7. If at first you don’t succeed, keep trying until you do (hopefully)
  8. Learning doesn’t stop with graduation
  9. Make time for yourself to recharge your batteries
  10. Despite everything we do, we will make mistakes, but try to learn from them so we don’t repeat them.

 

Chung

Betty Chung, DO, MPH, MA is a second year resident physician at the University of Illinois Hospital and Health Sciences System in Chicago, IL.

Resident Didactic Training – How Do You Learn Best?

Lately, I’ve been thinking about what I need from my residency training to become a competent pathologist when I graduate and how I learn best. I’ve never been a good audio learner so I don’t learn as much from a purely lecture-based education. And truth be told, I often skipped classes during medical school but wasn’t reprimanded probably because I did fine in my classes. It’s taken me years to realize but I learn best by making connections. Maybe it’s the scientist in me but I remember more, and can figure out the concept again if I forget it, if I understand mechanisms than by rote memorization. So for me, what I need most is time that often is not afforded in a live lecture. I often prefer to watch video recordings on pathology topics because I can stop the recording and think (or jot down a note or two). The “flipped classroom” concept works better for someone like me.

And so, this brings me to resident education. Unlike other specialties, we spend a lot of time on didactics. But there are many different permutations to how programs accomplish this objective. At my program, we have a lot of live lectures or multi-scope sessions. I faithfully try to attend (especially since we have a 90% attendance policy), but most of my attendings know that this is not how I learn best. Anything I have to learn by hearing on the spot has never been my strength.

But, I’ve found two methods at my program that do fit my learning style. First, we have a whole slide scanner. It’s great because we are allowed to scan slides to build our own virtual slide sets for repetitive study later if we so choose. Also, our surgical pathology director has given much of her time to annotating slides for us to use for “unknowns.” She can even compile data such as tracking how long it takes us to find an important required feature on the slide as well as our movements on the slide. She can also compare our scores from year to year if we use the same slide set (which we found didn’t significantly increase our knowledge if tested on the same subject the following year so we’re no longer required to do so).

With digital slides, I like having the option to go back and look over the slides as many times as I need. I didn’t realize how fortunate we were to have a slide scanner at our disposal until I presented some of this data at USCAP during my first year – many residents and attendings that stopped by my poster told me that they didn’t have access to digital slides or a slide scanner at their institutions. But looking at whole slide imaging (WSI) is a skill we all need to master since up to 2/3 of our AP boards can be digital (not glass) slides so I’m glad that I’m exposed to it early and throughout my training.

The second method that I found that really helps me to learn surgical pathology is the unknowns conference conducted at one of our four hospitals. We’re given four slides (which is the perfect number to cover in up to an hour) a couple of days in advance and the residents work together to come up with a differential and diagnosis. Since our attending always gives us papers on the diagnoses, we often read articles while we are working up the differential – which for someone who is used to reading journal articles and reviews, is right down my alley! We take turns during the conference driving at the scope and describe what we see at low then high power and then we give our differential and begin to narrow it down.

After each slide, our attending will reveal the correct diagnosis, point out salient morphologic features (especially with mimickers that can confuse us), and ask us about appropriate ancillary tests and expected results before giving us articles to read on the diagnosis. I’ve found that the interactive approach really helps but more so than that is the visual learning (ie – reading books and articles, googling on the internet) that I did to prepare for this conference. More important than getting the right diagnosis by “wallpapering” (ie – matching up a picture with the slide to reach a diagnosis) is the thought process to narrow down the differential.

And lastly, this is not specific to my program, but I am a strong supporter of open sourcing and sharing of free online didactics. I’ve often found great videos from other programs online or on YouTube to supplement my learning. So how do you learn best? Does your program provide all the tools that you need?

 

Chung

Betty Chung, DO, MPH, MA is a second year resident physician at the University of Illinois Hospital and Health Sciences System in Chicago, IL.