Tell us about your sub-I or elective
Hi!
Did you just complete an elective/ sub-I? 2 weeks or 4 weeks? If you’d like to share your experience, helpful resources, and advice on how to do well, please do so in the comments box below.
Thanks!!!
Here’s a link from studendoctor.net for those planning to match into general surgery. It’s about subIs you might consider taking.
http://forums.studentdoctor.net/archive/index.php/t-141465.html
Enjoy Beethoven’s Tempest Sonata mvt. 3 by Wilhelm Kempff
[youtube=http://www.youtube.com/watch?v=LfjD-DQ5REk&feature=related]
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Elective: Pathology elective at UCSF Pathology 150.03
http://labmed.ucsf.edu/education/other/electives-path-mlpathology.html
This is in draft form. I will edit this submission periodically. Hopefully it helps anyone who will be taking a path subI. Email me if you have questions.
Overall, I really enjoyed this rotation. It’s Tier II, meaning it’s low stress. Would highly recommend it to anyone considering pathology or who wants to get exposure to more path. It used to be required for students going into OB, and it’s definitely helpful for anyone going into surgery. Finally, no matter what you’re going into, path is an awesome elective to take before you graduate. It’s a great learning experience.
The pathology elective is run by Dr. Philip Ursell, director of the autopsy service at UCSF. Dr. Ursell runs this elective very well, providing you with computer access by the second day of the rotation. He stays in touch with you almost daily during the rotation, and is really helpful in guiding you while you prepare for your end of rotation presentation, which is optional.
Expectations are really up to you. You can get as much or as little as you want out of this rotation. Luckily, the rotation can be tailored to your interests, whether you are interested in pathology as a career, or in pediatric pathology or obstetrics/gynecology pathology, etc.
You will present your patient during autopsy conference, a time when residents present their autopsy cases from the week before. When you present your patient, you will discuss the clinical history (summary should include time course, why they were admitted, how they died); and also organs from the autopsy demonstrating the abnormal findings made during the autopsy that correlate with the clinical information. You can use powerpoint to show images of the pictures you took during the autopsy if that is relevant. You will discuss what you think of the cause of death, and conclude with a few minutes of teaching on a topic relevant to your case. One of the residents described the presentation like this: 1/3 clinical history (summary, time course, chief complaint). It is also a good idea to show any imaging from the history that might be helpful, for example, showing the MRI of a patient who had a brain tumor.
After you present the clinical history, you should then present the external exam, and then the internal exam. Point out abnormalities seen in the different organ systems that hopefully correlate with the patient’s presentation. Organs to include in your presentation include lung, kidney, heart, and brain.
Conferences: During this elective, you will attend a lot of different conferences. These are opportunities for you to learn some of the important topics in pathology. First off is the “resident’s core curriculum” which is 3 times a week. These are often presentations on a pathology topic made by a fellow or an attending. They’re quite interesting, but were very focused on specific topics that were clearly relevant and practical, but hard to grasp for someone just getting exposed to pathology.
The “unknown ” surgical pathology consensus conference occurs four times weekly. During this period, several of the attendings sit in front of a multi-headed scope, with the resident on the case and whomever else is interested, to discuss their thoughts on the hardest cases from that week. It is a great opportunity to learn how the attendings approach and think through difficult pathology cases.
You also get to go to SFGH and do some surgical pathology and become a familiar with the type of work done there and the attendings there.
Another great thing about this elective is that you get tutorial sessions. I had sessions from Dr. Rabban (cytopathologist/gyn), Dr. Vandenberg (neuropathology), Hemepath, Treselor (lymphomas), and Jones (pulmonary). These were excellent teaching sessions. On some of the tutorials, you are given a set of slides and asked to make a diagnosis, or as with Dr. Ursell, given a bunch of hearts (peds & adult) and asked to distinguish ischemic, valvular, hypertensive, pericardial, and cardiomyopathy. Dr. Ursell has a set of slides he gives you at the beginning that you go over with him at the end. He gives you some clinical history, and location of the lesion. With the information provided, you are asked to make a diagnosis.
I also met with Dr. Vandeberg, who an excellent teacher and expert in neuropathology.
Finally, there is an optional formal presentation that you do at the end of the rotation. I gave mine on Greig syndrome, and I will post part of it soon. Your autopsy report is also due at the end of the rotation. So, it might get a bit hectic. The presentation is about 30 minutes including questions. About a dozen people show up, including attendings, fellows, and residents. It’s quite fun, there’s food, and everyone is supportive and ask interesting questions. This talk however is expected to be very basic science oriented.
Another really cool thing is that you get to go to the medical examiner in san francisco and shadow for a day. I still have to do that, but I hear it’s a pretty spectacular place, and unfortunately, a very busy place, full of murder victims, suicide victims, and etc.
For the autopsies, you sign out the specimens to the neuropathologist and also the pathologist who was on autopsy when you picked up your patient.
For the report, the autopsy report booklet has all of the information you’ll need to put together a great report. You’ll need information like:
- the admission history
- lab values when admitted
- course of events
- events that help you understand the cause of death
- have the information in chronological order
- summarize from admission to death in 1-3 paragraphs
- know what steps happened between admission and death
Know their hospital course
- know the hospital lab values, imaging, etc.
- Put important labs where they below
Gross autopsy
At the end of the report you’ll have to write a little educational summary on one or more topics.
As far as doing the autopsies, you should ask Dr. Ursell to borrow his Autopsy book, and also review the autopsy booklet. But nothing will prepare you more than actually doing it with the resident. The resident will do the autopsy with you, and guide you through the whole process.
Some websites I found helpful before starting include:
- http://health.howstuffworks.com/autopsy.htm/printable – I found this to be a quick introduction to autopsies and how things work
http://www.pathguy.com/autopsy.htm – this is also a quick introduction to the autopsy process
http://www.thesmokinggun.com/archive/years/2007/0326071anna1.html – This website has an actualy autopsy report that you could review. (Those reports are actually pretty detailed)
http://www.aamc.org/students/cim/pub_pathology.htm – Find out about Pathology as a specialty
Suggested books:
A really great surgical path book that I used while I was at SFGH is called: Manual of Surgical Pathology by Susan Lester.
Rosai Surgical Pathology is an awesome book too.
There is a surgical path orthopedics book which I thought was excellent. I had a case of a knee cyst with mucinous content, and it was awesome to be able to open up the book and see different pictures of knee pathologies. The book is called “Orthopedic Pathology” by Peter Bullough. Both SFGH and Moffit have these books in the resident’s office.
These books also guide you in what to say during your dictations.
Finally, you will interact with a lot of really awesome pathologists who love to teach. One of them is Dr. Stephen DeArmond, a neuropathologist.
Overall, I had a lovely experience and would recommend this elective to any 4th year med student.
I just finished my medicine sub-i at Moffit, and it was intense but very incredible. I really felt like the staff and team members are incredibly bright, efficient, and good teachers. Youll learn a ton about “playing an intern”, and I really enjoyed the pts and their complicated problems. Tips for those coming on: (1) Attendings love it when you pick up pts when its just you and your R2 when interns are off (only if you have a light load of course). It really facilitates the team dynamic and helps the R2. (2) Brevity is key in presentations; for the HPI, just talk about the care minimum bc they can read the rest in your note. (3) The more friendly your voice is when you call to schedule studies or pull strings, the better response youll get!! (4) Communication with the nurses taking care of your pt is absolutely critical; theyre such a great resource and will help you do things throughout the day (like call MRI) if you need help! (5) Dont go to the Moffit cafeteria after 7 bc the grill will be closed and everything else to eat sucks. Coffee cart closes at 8:30. (6) Carry a blank copy of every damn form with you at all times of the day; you never know when youll see your R2 again to get things signed!!!!!!
One month at Moffet is great (but then again, Im going into medicine); good luck!
well, hi admin adn people nice forum indeed. how’s life? hope it’s introduce branch