Week One at UPMC Shadyside Hospital

Our big monthly test for October has come and gone and it has been a heavy load lifted from our shoulders. This test was the last test on which we had specific reading assignments. The questions for our next test will come from any of the material that we've learned so far throughout this program. I believe that most of us are feeling confident now and we are prepared for most of what will come our way. To cram now for our next test would be an impossible task due to the amount of material that we've covered. Of course, I'll still be studying the material on some of my weaker areas, but rather than focusing on the specifics I'll be focusing on the general. Honestly, if I had the option to take our next monthly test as well as the ASCP certification exam tomorrow, I would go ahead and do it.

This last week at Shadyside I got the opportunity to handle many of the "gross-only" specimens that Shadyside gets. The ones that stick out the most in my mind are the femoral heads and knees, although there are many other smaller specimens as well. When doing many similar specimens over and over, the usefulness of templates cannot be overstated. What would be a 15 minutes job by free dictation is cut down into nearly 5 minutes. Each gross-only case is reviewed by the pathologist before being signed out, but it's up to the PAs to create not just the gross description, but also the final diagnosis and any comments that are needed. So long as my microphone doesn't mess up or my computer doesn't suddenly restart things should be smooth sailing.

Shadyside primarily handles two organ systems; genitourinary and bone/soft tissue. For the next three weeks I will be assigned to one and then the following three weeks I'll be assigned to the other. Shadyside Hospital is well known among the UPMC system for their entire examination of every prostatectomy. One of the special things that they perform is to strip the prostate capsule and examine it entirely for any tumor invasion. It ends up being a lot of blocks that need cutting, however you can't get any more thorough than examining the entire prostate. If ever I develop a malignancy in my prostate (which I hope not) then I might highly consider flying to Pittsburgh to get it taken out.

It's unfortunate that the apartment that I'm currently living in is on the other side of town from Shadyside. The commute to get there is the longest of all of my rotations. It will cut into my studying time but I'm sure I can make it work. A storm is coming in which is going to make traffic horrendous. If all goes well our car won't be blown off the bridge during our commute.

Book Review: Most Useful Textbook Award

Well loved and well worn.

A few minor adjustments.

Time and time again, ever since the beginning of the summer pathology course to even now, I have found myself coming back to reference and study from this textbook. It’s the BRS Pathology 4^th edition by Schneider and Szanto. It can be thought of as a condensed version of Robbins which removes a lot of the side content and tells you the main points behind each individual pathology. In fact, I find studying from this bullet-point style book much easier than having to wade through paragraphs and paragraphs to get to the bottom of my answer in Robbins. The information is presented with as little flair as possible which leaves just the delicious tenderloin meat of pathology left over. What would take me a whole day in reviewing an organ system takes me no more than 2 hours.

This book not only serves for me as a quick reference and study guide, but also as a practice review. The end of each chapter is filled with up to several dozen practice questions that hit the main pathologies from each section. The questions are in multiple-choice, which also helps us to review for our board exam once we graduate. The questions cover a good variety of topics, but the difficulty could admittedly be a little tougher. After having reviewed the entire book over and over and over, one gets to the point where just by reading the first sentence you already know that the answer is C.

As a book which condenses pathology into understandable bite-sized portions there are some pathologies which are glossed over or omitted entirely. It does a fine job at introducing most of the pathologies, but for the successful pathologists’ assistant, only knowing “most of the pathologies” is not going to cut it. You can see that I have made some “improvements” and have written my own notes within the book. Whenever I have come across a pathology that needed more elaboration or was not included in the book, I write it in myself in the appropriate chapter. Over this past year and a half it has become a much more personalized item and if there’s an entry I need to look up I know from my own memory the approximate page it’s going to be in. It has also been useful for me to write in non-pathology notes in the pages, for example explanations of different surgical procedures or surgical hardware/tools.

The last minor irk that I have with this book is that it’s not made from titanium. I’m afraid one day it’s going to disintegrate into dust and be blown away by a strong gust of wind. It’s only because I love this book so much that it is falling into disrepair. 

I think that many of my classmates will agree that this book has helped them immensely throughout both years of this program. As for myself, it will continue to be of use even after the completion of this program.

Getting the Bigger Specimens

It's both a good and sad thing that the end of this rotation here at UPMC Presbyterian is nearing. There are still a lot of specimens left that I would like to see and it's always a pleasure to be under the direction of the PAs here. As time is running short these next two weeks I expect to perform only on larger specimens, which is precisely the practice and experience that I am looking for.

Recently, I had the opportunity to gross my first lung case. As it was my first time, as always, I prepared beforehand by reading up in the texts on how to approach the specimen. It's nice when you are still a student and have the leisure to double check on the different procedures, but in the working world there is no such room for brushing up. It seems that no matter how long one studies the texts at home, without the hands on experience the material doesn't stick. I'm sure that there must be research out there confirming that most people learn better with hands-on work over reading.

In any case, I am still working on my speed as much as possible. I know one thing that is holding me back is that I stumble when trying to say a description. I often try to describe exactly what I see and without a "word bank" of important words that pathologists and PAs like to hear, it can become cumbersome. Also, I find myself backtracking sometimes to insert additional words that make the sentence more descriptive, but it still ends up eating my time. For example, I might say something like, "the external surface is tan-red, roughened and displays numerous adhesions" but I forget to mention that there is soft tissue attached or that there is a focal area of granularity so I have to go back and edit the sentence. Fortunately, I am fairly proficient at moving around using voice commands, but each command takes about 1 second for the computer to register, and even that takes up time when you aggregate all of the commands that you sometimes need to make. The best thing to do is to not omit anything the first time so you make fewer commands and save time.

Studying is continuing as usual. Many of my classmates and I have already applied to take the ASCP PA certification exam as soon as we graduate. The fee this year is $515. I had always thought it to be ironic for someone to pay to take a test. The demand however is such that the organization can charge this much and still attract willing PA students. Supply and demand. I wonder if there are any other certifying organizations besides the ASCP for pathologist assistants. I tend to usually view competition as a good thing. Election time is nearing and it's probably all getting to my head now. Another few more months of focusing on school and then it will be time to worry about other matters. It will be a welcome change.