Learning path

[wholeheartedly]

Hey folks,

If you don’t already know me from my lurking and occasional posting. I’m a former clinical lab scientist/development tech, former hospital epidemiologist, current epi fellow. I’m not looking for career advising or pathology job outlook info in this thread, just my below question. (I’ve read all the other threads on here so pretty up to date on that other stuff).

I’m curious what it’s like learning path and becoming competent and comfortable with the work. I loved the clinical lab side of things, I’m a very visual person. I really enjoyed histology, thought it was challenging but interesting.

My issue comes in with something I observed as a tech outside my previous tertiary center. I hadn’t done hematology for awhile cuz at the big shop i was in blood bnking then core lab, where we just did automated cbcs/diffs then those that flagged for needing a manual diff got sent up to the heme specialty lab for further review.

At the rural shop I moved to, you do everything. I was a little rusty so I bought a hematology book with a good color atlas, did some online review courses/content for lab techs. I was pretty comfortable differentiating abnormal from normal and all the common cell types. But when I’d run into something really atypical or uncertain during my training period and ask colleagues, I’d ask like 4 people what that cell was, and get 5 different answers. Then the path would sometimes give a different answer than the heme lead and others. I trusted him of course, but sometimes it was like he thought it was a blast too but didn’t want to officially call it. So I never felt confident in what the heck I was looking at with the atypical or rare stuff because there never seemed to be consensus.

Did you ever feel like that during training? How do you learn what’s right in those situations?

I suppose volume helps a lot, hard to get comfortable with atypical stuff in a setting that doesn’t see a ton of it.

Aside from all the challenges and downsides in other parts of this forum, .i think pathology would be pretty interesting field, but that kinda concerns me.

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[mike-sheree]

I am no heme path but was a generalist for a LONG time. Every so often I would be asked to look at “a cell” due to concern it was a blast. One of the first things i’d do is see if they are anemic or thrombocytopenic. If normal, ( and WBC isn’t bizarre) it is almost certainly not acute leukemia. It’s even better if you have a clinical hx( not common to have) of viral syndrome.

 

[wholeheartedly]

There was one case with maybe 5-6 blast like cells, in a 10 year old presenting with fatigue and pain in different places. But specific situations vary quite a bit and I generally wouldn’t involve the pathologist about just one random atypical cell. That wasn’t really the question.

Really the question is, how often during training do you encounter uncertainty about the accuracy of what you’re learning (often discovered via discrepencies in what two different attendings or whatever might be telling you) and how do you resolve that so you feel comfortable and confident in your knowledge base when you’re done?

 

[octopusprime]

For things that are nuanced, all the time.
Heme: is this a blast or a slightly more mature white cell?
Derm: Is this melanoma in situ or a severely dysplastic nevus?
Breast: Is this atypical ductal hyperplasia or a b9 proliferative process
GI: is this low grade dysplasia or indefinite? high grade or carcinoma?
Cytology: is this cancer or really reactive?

there are SOOO many nuances in pathology, and while there is always a "right" answer, it may not always be obvious and requires incorporation with clinical...age, location, imaging, other symptoms... black & white answers don't always have black & white presentations.

 

[Spikebd]

For things that are nuanced, all the time.
Heme: is this a blast or a slightly more mature white cell?
Derm: Is this melanoma in situ or a severely dysplastic nevus?
Breast: Is this atypical ductal hyperplasia or a b9 proliferative process
GI: is this low grade dysplasia or indefinite? high grade or carcinoma?
Cytology: is this cancer or really reactive?

there are SOOO many nuances in pathology, and while there is always a "right" answer, it may not always be obvious and requires incorporation with clinical...age, location, imaging, other symptoms... black & white answers don't always have black & white presentations.

Great post

 

[wysdoc]

Hey folks,

If you don’t already know me from my lurking and occasional posting. I’m a former clinical lab scientist/development tech, former hospital epidemiologist, current epi fellow. I’m not looking for career advising or pathology job outlook info in this thread, just my below question. (I’ve read all the other threads on here so pretty up to date on that other stuff).

I’m curious what it’s like learning path and becoming competent and comfortable with the work. I loved the clinical lab side of things, I’m a very visual person. I really enjoyed histology, thought it was challenging but interesting.

My issue comes in with something I observed as a tech outside my previous tertiary center. I hadn’t done hematology for awhile cuz at the big shop i was in blood bnking then core lab, where we just did automated cbcs/diffs then those that flagged for needing a manual diff got sent up to the heme specialty lab for further review.

At the rural shop I moved to, you do everything. I was a little rusty so I bought a hematology book with a good color atlas, did some online review courses/content for lab techs. I was pretty comfortable differentiating abnormal from normal and all the common cell types. But when I’d run into something really atypical or uncertain during my training period and ask colleagues, I’d ask like 4 people what that cell was, and get 5 different answers. Then the path would sometimes give a different answer than the heme lead and others. I trusted him of course, but sometimes it was like he thought it was a blast too but didn’t want to officially call it. So I never felt confident in what the heck I was looking at with the atypical or rare stuff because there never seemed to be consensus.

Did you ever feel like that during training? How do you learn what’s right in those situations?

I suppose volume helps a lot, hard to get comfortable with atypical stuff in a setting that doesn’t see a ton of it.

Aside from all the challenges and downsides in other parts of this forum, .i think pathology would be pretty interesting field, but that kinda concerns me.

You can learn a lot on #pathtwitter - I started reading it recently for interest

Also there’s a new free learning platform, either on twitter or website @PathElective or pathelective.com I haven’t explored that one yet