Saturday, June 18, 2011

Gross Room Survival Guide Part 2. Reading

Grossing skills are essential for any practicing pathologist. Even if you are going to practice in a large academic institution with a squad of residents ready to jump out of their skins at your wish, you ought to know how to gross for several reasons. Firstly, you need to make it through your own residency in order to be able to practice. The ratio of grossing to study time varies by program, but even in the most lenient institutions you will be required to cut up specimens. When you do enter independent practice, you may end up in a place with no residents where you will be required to gross your own stuff. In any case, you should be able to guide your resident or PA in cases of unusual or complex specimens. You may be an excellent diagnostician at the scope but you cannot be a good pathologist without being good at the grossing bench. How do you learn grossing? The way that worked for me was supplementing hands on experience with some relevant reading.

Regarding reading, both before the start of your residency and during the first few months, I would leave alone the major pathology texts (and I am not talking Robbins, either). Those will come into picture later. And in order to find time to read them later you will need to be efficient at grossing to get it out of the way pronto. So what do you read? Manual of Surgical Pathology by Susan Lester is an excellent guide to surgical pathology grossing. It is concise, to the point and full of useful tips. This is probably the only book I would recommend to go through before starting your residency. I would not recommend buying it though. This is the kind of text you will probably read once during the first couple of months of training, and then very occasionally use for reference while grossing some obscure type of specimen. If you can get it on loan from a library or a friend – do it.

Another read that I find extremely useful and that is, unfortunately, rarely mentioned to new residents, are College of American Pathologists Cancer Protocols. They are not an easy read, and I wouldn’t read them at my leisure. The good way to go through them is before you are about to gross any particular type of specimen. If you have a gastrectomy on the schedule, read the CAP protocol for stomach that morning. Did you know that a stomach has four surgical resection margins? Those protocols bulletpoint all the information about the specimens that will have to be included on the diagnostic report. By reading those beforehand you will know what sections you have to take in order to answer those questions. Explanatory notes that follow each protocol are also a mandatory read. Last but not least – the protocols are available on the CAP website for free.

The above two sources are probably the only ones I would use, at least for the first couple of months. You may want to start flipping through Sternberg or Rosai once you settle in and start your signouts with an attending (more about that later). To get a basic grasp of immunohistochemistry I would recommend Immunohistochemistry Vade Mecum, an excellent online resource by Dr Paul Bishop.

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