So I finally remembered to ask some of the first years if anyone would be willing to write up a short blog entry about what their classes are like this year compared to ours last year. I know changes have been made, so we'll see if one of them has some spare time to jot their thoughts down.
Also, for people who have been going through interviews, if anyone would like to share their interview experiences at any of the PA programs I'd love to post them!
In other news, so sorry for the silence. I have a list of things I've jotted down that I want to blog so I won't forget them. My laptop has been having issues so as a result I've just avoided being online much lately. I've taken it to the med education IT help desk a couple times, but so far no improvements. It has meant things like missing out on emails reminding us that our autopsy conference is one place instead of the normal place (that was a bad morning!) and such things.
Speaking of autopsy, I'm back on autopsy after a three week stint at Duke North. It was a good rotation, lots of different complex specimens, and I had a practical exam. It is harder grossing with a staff PA over your shoulder watching you with a critical eye, but it went well. I got an A so I'm not complaining in the least and it was great getting that feedback.
Next week is spring break and I'm going to spend mine going back to South Carolina to do home improvements because I love painting, but until then I'd like to have a busy rotation this time around. Brain cutting today was really busy with med students and first year PA students, but we had some very interesting cases so it was good that everyone got to see those. There was a great moment when the neuropathologist was quizzing the students on neuroanatomy and the first year PA students were getting all of the answers right, so she had to tell them that they weren't allowed to answer any more questions. They did an awesome job and all PA students can name the locus coeruleus thanks to one of our staff PAs!
Showing posts with label Duke Surg Path. Show all posts
Showing posts with label Duke Surg Path. Show all posts
Monday, March 18, 2013
Wednesday, January 16, 2013
This week in frozens
This is my third week at Duke North on this rotation, which means I'm doing triage/frozens.
Triage varies by specimen, but almost everything gets weighed, measured, or both. Margins may be taken, specimens may be inked for orientation, and opened up or bread loafed (sectioned but not cut all the way through) to allow better formalin fixation. Some specimens may be pinned out on cork boards so they fix in the shape they are pinned into (useful for things like an esophagogastrectomy). And everything gets put into adequate formalin. Larger specimens are held until the next day for grossing, which is nice when you're a student picking out the cases you'd like to do for the next day.
Where I worked before didn't do that much with triage. Sometimes we would open the colon specimens, and sometimes we would ink mastectomies for orientation and bread loaf them. Colons and breasts were held until the next day, but everything else was grossed the day we got it. Most of our specimens were received in formalin, but larger things like spleen and liver were usually not. And being in formalin isn't the same thing as being received in enough formalin! Sometimes there was so much specimen crammed into a container that there was just a splash of fixative on it and most of the tissue was still unfixed. So I can appreciate that the PAs or residents doing triage at Duke are the ones ensuring there is enough fixative, and that there is enough flexibility on the the turn around time that things can be held for a day.
Frozen sections are interesting. We go with the staff PA or resident to the operating room and are handed the tissue of interest to take back to the gross room. Then we triage the specimen and whatever section(s) we need are taken and given to the techs. The techs section the tissue and stain the slides. The staff PA works with the tissue bank/research folks to provide needed tissues at that time as well if they can. The pathologist reading frozens that day may see the specimen or ask for additional sections, but once they are done the specimen is put into formalin and accessioned.
It has been nicely steady and I've gotten to work with one of the staff PAs that I haven't worked with before. Plus, I've worked with several residents which isn't something that happens often when we're at Duke North. It is good to get to learn from so many different people.
In other news, today is my dad's birthday! We had a small family celebration at home.
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| Pinned specimen from this site |
Where I worked before didn't do that much with triage. Sometimes we would open the colon specimens, and sometimes we would ink mastectomies for orientation and bread loaf them. Colons and breasts were held until the next day, but everything else was grossed the day we got it. Most of our specimens were received in formalin, but larger things like spleen and liver were usually not. And being in formalin isn't the same thing as being received in enough formalin! Sometimes there was so much specimen crammed into a container that there was just a splash of fixative on it and most of the tissue was still unfixed. So I can appreciate that the PAs or residents doing triage at Duke are the ones ensuring there is enough fixative, and that there is enough flexibility on the the turn around time that things can be held for a day.
Frozen sections are interesting. We go with the staff PA or resident to the operating room and are handed the tissue of interest to take back to the gross room. Then we triage the specimen and whatever section(s) we need are taken and given to the techs. The techs section the tissue and stain the slides. The staff PA works with the tissue bank/research folks to provide needed tissues at that time as well if they can. The pathologist reading frozens that day may see the specimen or ask for additional sections, but once they are done the specimen is put into formalin and accessioned.
It has been nicely steady and I've gotten to work with one of the staff PAs that I haven't worked with before. Plus, I've worked with several residents which isn't something that happens often when we're at Duke North. It is good to get to learn from so many different people.
In other news, today is my dad's birthday! We had a small family celebration at home.
Monday, November 5, 2012
Rotated through and now back to autopsy
Friday was my last day doing surgical specimens for a while. It was a good five weeks and I feel a lot more comfortable at Duke surg path. I know that I still have a ways to go on getting my dictations where I want them to be but I did get a lot more positive feedback on them on them this go-round.
We have case assessments where the pathologist who reads out the case can comment on our dictations and sections on the cases that we select for assessment. And it can be disheartening some times when the staff PA looks over the blocks being submitted and praises the sections but the assessment comes back with the pathologist not liking them... or having one pathologist wanting larger sections and another wanting smaller ones. That is all part of the learning process. It isn't easy or fun to get feedback (unless it is 100% enthusiastic and positive, because who doesn't love that?) but it is helpful.The good thing about being able to handle constructive criticism and apply it is that it means that there should be improvement. Learning to tailor your sections to the pathologist reading them is a very important professional skill!
Still, I really enjoyed my time on surg path. I felt like things were starting to become more comfortable and familiar at Duke. And I was able to answer the questions the staff PAs put to me about the disease processes going on in the specimens I was grossing and what sections needed to be submitted, etc. It was nice to feel confident about that.
Meanwhile, as of this morning I am back on autopsy for two weeks. Oh autopsy! You never know what the work load is going to be, but I like it a lot - more than I thought I would before I started the program. The one thing I miss equipment-wise is a scale that you can wheel the gurney on to get the patient weight. But other than that, it is great. Everyone that works there has been working there for years and teaching for ages so they're very focused on us as students. Plus, most of the organs are relatively normal (which is not something you get too often in surg path) and it helps reinforce anatomy information. During this rotation I'd like to get evisceration down, which everyone seems supportive about so hopefully we'll have some cases that are good for teaching (ie: there's not a recent thoracic or abdominal surgery in the patients that would require a more experience hand for evisceration, etc).
In completely unrelated news, the first years had their first gross anatomy practical this morning. Oh goodness, I remember being in their position last year... it hits at the end of a solid month where there was a test in a different subject every Monday. Hopefully they're all recovering from all the studying but having a relaxing night. It is one of those situations where it feels like it has been forever since we were doing that and no time at all.
We have case assessments where the pathologist who reads out the case can comment on our dictations and sections on the cases that we select for assessment. And it can be disheartening some times when the staff PA looks over the blocks being submitted and praises the sections but the assessment comes back with the pathologist not liking them... or having one pathologist wanting larger sections and another wanting smaller ones. That is all part of the learning process. It isn't easy or fun to get feedback (unless it is 100% enthusiastic and positive, because who doesn't love that?) but it is helpful.The good thing about being able to handle constructive criticism and apply it is that it means that there should be improvement. Learning to tailor your sections to the pathologist reading them is a very important professional skill!
Still, I really enjoyed my time on surg path. I felt like things were starting to become more comfortable and familiar at Duke. And I was able to answer the questions the staff PAs put to me about the disease processes going on in the specimens I was grossing and what sections needed to be submitted, etc. It was nice to feel confident about that.
Meanwhile, as of this morning I am back on autopsy for two weeks. Oh autopsy! You never know what the work load is going to be, but I like it a lot - more than I thought I would before I started the program. The one thing I miss equipment-wise is a scale that you can wheel the gurney on to get the patient weight. But other than that, it is great. Everyone that works there has been working there for years and teaching for ages so they're very focused on us as students. Plus, most of the organs are relatively normal (which is not something you get too often in surg path) and it helps reinforce anatomy information. During this rotation I'd like to get evisceration down, which everyone seems supportive about so hopefully we'll have some cases that are good for teaching (ie: there's not a recent thoracic or abdominal surgery in the patients that would require a more experience hand for evisceration, etc).
In completely unrelated news, the first years had their first gross anatomy practical this morning. Oh goodness, I remember being in their position last year... it hits at the end of a solid month where there was a test in a different subject every Monday. Hopefully they're all recovering from all the studying but having a relaxing night. It is one of those situations where it feels like it has been forever since we were doing that and no time at all.
Wednesday, October 31, 2012
At the end of October
I'm glad to say that I survived making yet another costume (pictures possibly to follow since our class went out as a group and mostly dressed up) and like every other year I've made a costume I have vowed NEVER AGAIN. Of course in about eleven and a half months, I'm sure it'll seem like an excellent idea to make a costume again.
I've also survived two and a half weeks of my three weeks at Duke surg path. The second go-round has been much less stressful than the first time since I've already seen a lot of the specimens before. It is still a learning curve. Right now I'm working on making sure my dictations clearly cover everything they need to cover. It is good practice to do free dictations to figure out the cadence and descriptions that work best. So I practice.
I've also been forcing myself to use the normal scalpel since they have had trouble getting the blades that I love and not everything needs a trimming knife. And it can't hurt to learn to be more flexible about the type of equipment I'm used to using since different locations stock different things (or, like my favorite scalpels, they might go on back order).
I've also survived two and a half weeks of my three weeks at Duke surg path. The second go-round has been much less stressful than the first time since I've already seen a lot of the specimens before. It is still a learning curve. Right now I'm working on making sure my dictations clearly cover everything they need to cover. It is good practice to do free dictations to figure out the cadence and descriptions that work best. So I practice.
I've also been forcing myself to use the normal scalpel since they have had trouble getting the blades that I love and not everything needs a trimming knife. And it can't hurt to learn to be more flexible about the type of equipment I'm used to using since different locations stock different things (or, like my favorite scalpels, they might go on back order).
Monday, October 22, 2012
Wish list...
I think I've talked about it before but when we're at Duke North we have a board where we can write down the specimens that we'd like to have first dibs on if one happens to come in. I always have a hard time trying to figure out what to want since I feel like I'm consistently getting a good cross section of organs and disease processes.
I have jotted down a few things though. I'm not ambitious enough to be asking for a whipple just yet, but I wouldn't be opposed to an esophagogastrectomy coming across my table or a laryngectomy. Which might be more about the fact that some of my classmates have done those specimens and I don't want to feel like I'm lagging behind, or I'm not where I should be.
I have jotted down a few things though. I'm not ambitious enough to be asking for a whipple just yet, but I wouldn't be opposed to an esophagogastrectomy coming across my table or a laryngectomy. Which might be more about the fact that some of my classmates have done those specimens and I don't want to feel like I'm lagging behind, or I'm not where I should be.
Monday, October 8, 2012
What I did on my summer rotation
I thought it might be interesting for folks considering a pathologists' assistant program to see the types of specimens that I encountered and grossed during my first rotation (it was summer so it meant only one pass through Duke surgical pathology and the VA surgical pathology, and that we were brand new students so the complexity is not what it will be). This is not a comprehensive list, since I am not including specimen number counts and it doesn't include autopsy at all. Also, I'm not breaking it down by location to keep things vague since these are specimens that could be received on either rotation and I tend to overcompensate when it comes to not violating social media policies.
Summer rotation specimen list:
Lumpectomies
Radical mastectomies
Reduction mammoplasty
Sentinel lymph nodes/node dissections
Foreskin
Nephrectomy (partial and radical)
Prostatecomy (radical)
TURP (prostate chips)
Vas Deferens
Thyroidectomy for neoplasm
Liver wedges
Hepatectomy (total and partial)
Amputation specimens
Lipomas/Hemangiomas/lymphangioma
Assorted orthopedic specimens
Appendix
Colon resection (with and without anus, with and without appendix)
Gallbladder (routine and for suspicion of neoplasm)
Small bowel resections
Stoma takedown
Fetus
Hysterectomy (for fibroids and neoplasm, simple and radical)
LEEPs
Ovaries (benign and neoplasm)
Placentas (singletons and multiples)
POCs
Pneumonectomies (native lungs for transplant patients and neoplasms)
Pneumonectomies (wedges/partial)
Tonsils
Assorted smaller specimens of varying types/complexity
It feels like a pretty solid start to my clinical year! The fall semester has already had some interesting specimens pop up, but I'll save those for later.
Summer rotation specimen list:
Lumpectomies
Radical mastectomies
Reduction mammoplasty
Sentinel lymph nodes/node dissections
Foreskin
Nephrectomy (partial and radical)
Prostatecomy (radical)
TURP (prostate chips)
Vas Deferens
Thyroidectomy for neoplasm
Liver wedges
Hepatectomy (total and partial)
Amputation specimens
Lipomas/Hemangiomas/lymphangioma
Assorted orthopedic specimens
Appendix
Colon resection (with and without anus, with and without appendix)
Gallbladder (routine and for suspicion of neoplasm)
Small bowel resections
Stoma takedown
Fetus
Hysterectomy (for fibroids and neoplasm, simple and radical)
LEEPs
Ovaries (benign and neoplasm)
Placentas (singletons and multiples)
POCs
Pneumonectomies (native lungs for transplant patients and neoplasms)
Pneumonectomies (wedges/partial)
Tonsils
Assorted smaller specimens of varying types/complexity
It feels like a pretty solid start to my clinical year! The fall semester has already had some interesting specimens pop up, but I'll save those for later.
Tuesday, July 17, 2012
In which I discuss my love of scalpels!
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| Pathco Scalpels are my favorite! |
a second year I've never had a chance to work with before and it was a good experience (she was instructive without being overbearing which is always nice when you're in a new situation!). But... I may have frightened her with how excited I got over finding a pathco doubled edged scalpel at Duke surg path. I was so happy to see that one of the PAs that now works there has had a few of these ordered (the PA in charge of the lab had offered to order a few for the current second years to use after they saw some at the conference last year but no one really wanted to use them). It might be that the double edged scalpel seems less safe, but you get used to it pretty quickly and it is convenient to be able to flip it over and have a new, sharp cutting surface.
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| Sakura Tissue Tek Trimming Knives (I like the flat ones!) |
I went to the movies with one of my best friends in Durham, who happens to be one of the few people I know in the area from outside of school, and my enthusiasm for discussing how awesome scalpels and trimming knives are may have worried him. Just a little. I think, since my best friend is a nurse, my sister is a doctor, and most of my other friends are either from school (undergrad or Duke) or have been hearing about the awesome (if messiness) of my job for the past four years, I forget that there are people for whom waxing poetic about the handiness of a sharp blade is unsettling!
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