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Morningmoon: My Pathology Observation at OSU
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Morningmoon: My Pathology Observation Thoughts and Experiences at OSU
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◇ 现代医学vs中医
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◇ USMLE/专科复习和考
◇ 力刀美国医学教育专

My Pathology observation thoughts and experiences at OSU


1. Overwhelming first day of observation

11:50pm, I laid in bed exhausted physically yet still exciting mentally, what a rich and overwhelming day! I’ve seen so much, heard so much and learned so much…. And I cannot help to write some of my thoughts today – for a memorization of my first day and first step into the real world of pathology!

First of all, the facilities and equipments in Surgical Pathology dept in OSU are so amazing. When I first entered the grossing and frozen section room, I saw several staff busy with processing various samples, colon, breast, bone, kidney, etc, yet I didn’t feel anything abnormal, then I suddenly realized how come there’s no smelling at all with all the fresh or formalin soaked human tissues in the room? The answer is that they have a really strong vacuum system over each bench which continues working and keeping the air in the room fresh. In the grossing area, each bench is equipped with a LCD as well as a microphone hanging over the wall, so very convenient for the pathologist assistant to do grossing while referring to the patients’ complete record in the computer and then give the dictation over the microphone at the same time. The other area is for frozen section, a bench for sample processing and several section machines, a microscope with large LCD display for the pathologist to read and demo the slides. Convenient, organized environment leads to efficiency and pleasure in work.

All the peoples are really nice here, from the attending physician, PA to office staffs. Dr He showed me around, went through all the paperwork with me and gave me really useful suggestions on how to make a good start and get the maximum of every valuable day here. He and another Chinese attending also showed some interesting cases and talked about some basics of reading slides under microscope to make diagnosis, grade, prognosis, etc. The Pathologist assistants here are all well-trained, I’ve learned a lot with them by watching them doing the grossing and frozen section. They are also very nice to offer me help and answer any questions I asked no matter how basic it may sounds to them, one of them is so kind that she even taught me how to operate the frozen section machine and let me practice on some useless samples. When I watched them to do it, it seems very easy, however, it turns out to be so difficult when I try to do it by myself. So never look down any tiny stuff without your own experience, my first lesson today.

My second lesson is to find myself not able to correlate the medical knowledge with the real world, which is somehow frustrating. Although I got pretty good step1 and 2ck scores, when I watched the attending in charge of frozen section read slides, decide whether malignant or benign and release report in just several minutes, I realize how far away I am from a real pathologist. The truth is I even didn’t look clearly at the samples, I have no clue at all what cell and tissue it is and I was thinking to myself to switch to a high power of microscopy, the attending has finished reading, dialed to the OR telling the results. Oh my goodness, that’s done? My brain still is complete blank. So lesson 2 today, steps score means nothing if we cannot transform the knowledge into the real world. There’s just so much to learn, to absorb and to digest.

What a day! My first day observation in pathology real world, I know I still have a long long way to go ahead, yet I look forward to step onto this journey full of excitement, versatility and challenge. I know I will get to the endpoint one day and look back all my previous footprints to be proud of myself. For that day to coming, I tell myself – good start, work hard and keep going!

2. Autopsy – how scare could it be?

Pathology has become a more and more competitive specialty nowadays, even for American medical students due to its better lifestyle and reasonable income. Here in OSU pathology dept., 12 out of 14 residents are AMGs with the remaining two being the CMGs. However, it still opens its door more widely than all other specialty to us old CMGs with some research experiences. I know many CMGs are considering applying for Pathology program just like me myself, yet one major concern hesitating some of us, especially females without previous pathology experience, is autopsy. Autopsy, how scare could it be? Am I able to do it? Will I feel extremely uncomfortable? With all these doubts, I watched first autopsy on the 3rd day of my observation.

It came unexpected, just when I was in the FS room observing around noon, Dr He told me there’s a body arriving and we then hurried to the autopsy room. On the way there – a long underground tunnel, I started to feel a little anxious, all my previous related experiences were in medical school studying human anatomy, which is a long time before. Then we reached the place, a bright, spacious room with music. It’s a bit stinkier than grossing room, but after completely equipped by wearing the face mask, cap, shoe cover and protective clothes, I feel much better. Two autopsy staff, one first year pathology resident and a PA student were already there. The body was kept fresh in freezer for 1 day, with face and private area of the body covered with some cloth. No time to think more, the autopsy started. It was a complete autopsy, which means all internal organs are to be taken out for pathology analysis. The procedure was that the 2 autopsy staffs opened the body and took out the various internal organs in one piece and then passed on to the resident and PA student to check if there’re any major abnormalities, resect some typical areas and send for histology analysis later, then fill a form/report. It sounded simple, however, time flied by without being noticed when it’s done. Quite a physical challenge to me – near 5 hours’ standing up and keeping still most of the time.

Honestly, I did feel a bit uncomfortable and nausea during the first hour, it’s lucky I didn’t have my lunch before otherwise I may throw up. However, those feeling disappeared little by little as time went by. Especially after all the organs were taken out and the resident started to check the abnormalities, my mind was then occupied more by paying attention to the pathologic change of the organs. The resident was also a very nice one who explained to me each of his step and answered every of my questions. He also told me that autopsy is one of the rotations during 1st year of residency, the board requirement is at least 50, he’s already done more than that and I can see he’s really very familiar now.

I was totally exhausted after observing a whole afternoon’s autopsy, but I am very happy I went through it and get rid of my previous concern. I don’t think anyone will really enjoy it, but it’s also not that scaring. One may feel uncomfortable during 1st time exposure, but I believe it could be overcome with our strong nerve and will, which we all have at the moment we determined to fulfill our dream – being a Chinese physician in US.

3. Some thoughts at the end of my observation in Pathology

Before typing this topic, I read again the previous ones I wrote when I just started my observation, I could recall the excitement, anxiety and ignorance at that time. Now approaching the end of observation, the initial excitement and anxiety both faded, my knowledge in Pathology is still poor, so what have I gained? I would say: determination and confidence. I would like to share some of my thoughts with any of us CMGs who will find it helpful.

First of all, I will suggest anyone considering Pathology residency program to do an observership before application, particularly those without previous working or research experiences in pathology like me myself. Before the observation, my whole understanding of pathologist’s life is through internet and consultation with friends who’s in this field. However, just like an old Chinese saying, hearing a hundred times is inferior than seeing one time. Only by observation could one better understand a pathologist’s job scope, daily routine, responsibility, and so on, thus decide whether you fit into this specialty or not and if you would like to commit yourself to choose pathologist as a life-long career. Different people have different view of point. For me, I favor more in a better lifestyle – pathologist work in regular hours, rare night calls and don’t have to round at weekends, just perfect for one who want to balance both career and family. Pathologist deals with other medical professionals instead of patients, which is very straightforward – another gain point in my view. However, most time pathologist sits before the microscope for hours to read slides and sign out cases, some may find it boring, but for me it’s much better than rushing to wherever place whatever you’re doing whenever a blue code is called. So again, it’s totally personal decision, interest plays a very important role.

Secondly, I think doing an observation will booster one’s confidence in future interview greatly. Although it’s not possible to master a vast amount of knowledge in pathology in such a short time, I did acquire a lot common sense, basic rules and general guidelines in various fields of pathology. This definitely helps in writing personal statement, and I am sure it should also help if I will have any interview in pathology program in future – I will be more confident sitting before the PD, knowing what they’re talking, what are the questions I should ask, and what are the most important qualities they are looking for.

Finally, I am so grateful for this observership opportunity all thanks to Dr. He. I tried my best to perform well. This is such a valuable chance for me. I am one in the category without any internal connections, no US PhD – so no home school here. I am sure there’re a lot CMGs with similar background as me. It’s really hard to get an observership without knowing any internal persons. My experience is to try the best to improve any other qualities or credentials you can control including steps scores, oral English, and then don’t miss any chance to build a connection, so whenever a chance appears to you, be ready to grab it.

My observation in pathology ends, this experience will be a big plus for my application for sure, I really hope I can make it next year, and wish everyone of you reading my writing – to fulfill your dream one day!

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