Pathology, the course that separates the physicians from the non-physicians
Our biggest and grandest course during my second year of medical school was Pathology. It was a year-long course that featured a mega-load of the things that physicians would spend the rest of their professional lives, dealing with. Our first semester consisted of Systemic Pathology and covered topics like Infection, Malignancy, Necrosis, Inflammation and Genetic Disorders. Our second semester covered all body systems and their pathology. This flagship course became my favorite because of the veritable “feast” of facts and tools that it would provide for my future practice.
Pathology was taught by a cadre of incredible professors, some of whom are internationally renowned. The single quality that all possessed was an ability to make the student as fascinated with their subject matter as they were. From our first lecture on Shock and Necrosis to our last lecture on The Pathology of the Male Reproductive System, our professors were just great. They came, armed with slides and the stories behind those slides. Many came with summary handouts that allowed review for USMLE (United States Medicial Licensure Exam) Step I, a breeze. I have every pathology handout and note sheet even today. If I need a quick review of every leukemia, they are literally at my fingertips thanks to my pathology professors.
To prepare for this class, I kept a very strict weekly schedule. We had a very thick syllabus that contained all lecture objectives and a very detailed textbook with readings for each lecture. By reviewing the syllabus and reading the test, I was able to sit in class and enjoy the explanations of every slide. I could take a note here and there which enabled me to remember the finer points of the pathology. My daily reading for this class was about 200 pages and my study for each lecture was about 250 pages. It was time-intensive but worth every second.
Along with lecture, we had pathology lab. These labs might be a conference (in the case of post mortem reviews) or might be our twice-weekly tutorial sessions. In our tutorial sessions, we were divided into three labs with each lab containing a pathology professor. The professors would shift but we would stay in our respective labs as assigned. We also had a wonderful gross pathology professor who provided a DVD video of every gross specimen presented for each exam. Those DVDs are golden because I can pop one in my computer and appreciate the fine points of a nutcracker esophagus or polycystic renal disease.
For each lab, we brought our slide boxes and microscopes so that we could follow along with the professor who was using the teaching microscope. These sessions taught us how to examine each pathological condition with the guidance of an excellent pathologist. Not only did we have the laboratory sessions but in between sessions, we could take our slide boxes home for review at home. Every Friday, I brought my microscope home for review of the previous weeks slides. I was also able to borrow additional slides from my professors in the pathology because I loved the study of pathology.
The other thing that I did that I believe made a huge difference in my approach to microscopic pathology, was develop a keen eye for the normal. During first year, I excelled in my histology class so that by second year, I was adept at surveying slides and identifying complex pathology. When I received a slide box, I took it home, got our a roll of lens paper and Windex. I cleaned every slide and arranged them according to lab and lecture. As each week went by, I had my slides clean and ready. I had also reviewed them carefully so that I knew what to look for in lab.
We were tested by microscopic and gross laboratory exam in addition to project and lecture exam. There were three exams for each exam period including the final exam period each semester. It is easy to see why Pathology took a major chunk of our attention during second year. I loved every second of these lectures, labs and conferences. To this end, the chairman of the department invited me (also based on my grades too) to apply for a well-paying Pathology fellowship that I would participate in during the summer between my second and third year.
The “catch” for participating in any second-year summer fellowship was that a student was required to take USMLE Step I, earlier than the rest of the class. I took my exam the second week of May after our classes had ended on April 28. Because I had excelled in Pathology, a solid review was all that I needed for this exam. I was very nicely suprised when I received my scores, at the end of June, that I had done quite well on this exam too. Pathology was indeed, a very good class to love and excell in.
My Pathology Fellowship allowed me to rotate as a medical student through two Offices of Medical Examiners. One of these offices was in a very large city and the other was quite suburban. I worked alongside the Medical Examiners (or a deputy) as we examined crime scenes and performed forensic post mortem exams. We were often asked to identify remains as human or non-human which was one of my favorite tasks.
I also worked the pathology end and performed Bone Marrow Transplants. This consisted of the harvest and infusion of stem cells. In addition I studied granulocyte transfusions and transfusion reactions. My pathologist mentor for Transfusion Medicine had a profound influence on the manner in which I practice medicine today. He was an excellent professor with a wonderful staff who was quite willing to show an eager medical student all aspects of Transfusion Medicine.
I was also required to attend all clinical conferences with the residents. These conferences generally entailed a discussion of the most complex cases that had come in for the week. A pathologist could call a conference within 24 hours if there was a great case. Our GI pathologist was trained at Massachusettes General Hospital and took great pains to make sure that the pathology residents (and me too) approached the complicated cases in a systemic manner. This was great teaching. At conference, we all sat around a table with microscopic viewers while the presentor “drove” the slides. At first, it was difficult to keep up but one of the residents spent an afternoon getting me up to speed. After his tutorial session, I could keep up with the slide driver and learn far more that I thought possible.
The best part of my experience during that summer was securing crime scenes with my mentors in the Medical Examiners office. I would hear news reports about the crime scenes that we had investigated and would often chuckle at how the news media would “get it wrong”. I also went along with the deputy medical examiner had to provide court testimony. This was a good learning experience too. It wasn’t like “Crossing Jordan” because the Medical Examiners office was not involved in the actual detective work. The M.E. provided as much information as could be gathered from the body and crime scene as it involved the body. I learned how these reports are put together and how important scientific observation and experiments are to solving a crime, not to mention, that I know how to “secure” a crime-scene so that valuable evidence is not lost.
As I entered third year, I was strongly considering becoming a pathologist. I certainly had a strong interest in the body of work and my graduate degree was an asset as I was well-versed in designing experiments and making observations. Even today, I always review my surgical pathology slides with the pathologist. All of the pathology residents and pathology attendings know me quite well and joke that I am a “closet” pathologist. I also include my surgical pathology slides in my presentations during Mortality and Morbidity conference (more about that in a later blog).
The study of medicine is unlike the study of any other body of knowledge. It requires an insatiable curiosity and anal perservance to “get it right” every time. There is a mountain of facts and experiences that a medical student must have to become a good physician. I was fortunate enough have some great professors who guided me through the learning process. I was also fortunate to have the energy to spend the hours needed to master my coursework. Pathology took many hours to master and pushed my discipline to the limits. In the end, it was worth every second because Pathology is the single most important pre-clinical course for any medical student. Pathology coupled with the rest of our pre-clinical studies made us physicians. In the end, it was great to see the transformation.