Pathology

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Pathology Review and Practice Guide
Excerpt

INTRODUCTION

 

Knowledge is the foundation of excellent pathology practice and excellent outcomes on exams. This book helps build that foundation in a comprehensive yet concise format. It is a solid reference for practicing pathologists, and provides excellent preparation for the US and Canadian pathology exams.

 

The US and Canadian pathology exams differ in format: the US exam is entirely written and multiple choice; the Canadian exam has a written and an oral component, and the written component is entirely short answer.

 

For this reason, the exam strategies discussed below cover different formats, and the book itself includes short answer questions and multiple choice questions.

 

GETTING READY FOR THE EXAM

 

A Structured Study Plan

 

In addition to reading cases, a structured study plan should include a thorough and systematic reading of Robbins and Cotran Pathologic Basis of Disease and of a surgical pathology textbook (either Sternberg's Diagnostic Surgical Pathology or Rosai and Ackerman's Surgical Pathology). Pay particular attention to definitions, fundamental terms, and concepts. Make lists and tables for comparison and grouping. Focus on subspecialty books during your rotation of that subspecialty. When it is closer to the time of the examination, go over old examination questions and collections of images to help you objectively assess your knowledge and your weaknesses.

 

Group Study

 

If there are more than 3 people writing the examination, it can be helpful to get together regularly to go over old examination questions, slides, gross images, and so on. As a group, go over a chapter or a topic in Robbins and Cotran Pathologic Basis of Disease and brainstorm possible questions on the areas you think are important.

 

Literature Review

 

Glance over the last 3 years of the American Journal of Surgical Pathology. This should be sufficient to keep you up to date on this field. Advances in Anatomical Pathology has some very good review articles that can help you quickly update your knowledge on specific topics. You also need to be aware of any new tumor classification systems in the most recent editions of World Health Organization publications.

 

Practice Exams

 

In the 3 months before the examination, try to systematically gain exposure to all subspecialty experts in your department. Trust yourself and your program. If the resident training committee thinks you are doing well, and you did well on your department exams, you will do fine on the pathology exam.

 

HEADING INTO THE EXAM

 

In Canada, you must bring a microscope to the exam. In the US, you can bring your own microscope, but microscopes are also supplied.

 

If you bring a microscope, also bring a slide, a back-up light bulb, and a filter. Use the slide to adjust your microscope.

 

If you have to travel to a different time zone for the exam, consider arriving 2 to 3 days early to avoid jet lag. No matter where the exam is held, give yourself at least a day to become familiar with the examination venue and your route to the venue.

 

Know your examination schedule well. Get to the site at least 15 minutes early to allow time for preparation, sign-in, going to the washroom, finding your seat, and so on.

 

TAKING THE EXAM

 

The Basics

 

Before you begin taking the exam, enter all pieces of required information on your answer sheet. If you forget to enter your name and ID number, your results may not be scored. Do not bring personal electronic devices into the examination room. Do not communicate with fellow examinees while the exam is in progress. Do not comment about the wording of questions in your answers.

 

Strategies for Unknown Lesions

 

First, try to categorize the lesion as neoplastic or nonneoplastic.

 

Nonneoplastic lesions can be classified as congenital, inflammatory, or infectious.

 

Neoplastic lesions can be classified as benign or malignant. Malignant neoplasms can be primary or secondary. Most neoplasms can be further classified into the following 3 subcategories based on cell lineage or origin: epithelial (carcinomas), stromal (sarcomas), and hematopoietic (lymphomas, leukemias).

 

Strategies for Multiple Choice Questions (US)

 

- Anticipate the correct response while you read the question. If you see the response that you anticipated, circle it and then check to be sure that none of the other responses is better. If you do not see the response that you expected, use the following strategies to eliminate responses that are probably wrong:
- Responses that use absolute words, such as "always" or "never," are less likely to be correct than ones that use conditional words such as "usually" or "probably."
- "Funny" responses are usually wrong.
- If you can identify more than 1 correct response, "all of the above" is the correct answer. "None of the above" is usually an incorrect response, but be very careful not to be trapped by double negatives.
- The longest response is often the correct one.
- A response that repeats key words that are in the body of the question is likely to be correct.
- If you have no idea of the correct answer, choose response b or c. Response a is least likely to be correct.

 

- If you cannot answer a question within a minute, skip it and come back to it later.

 

- Transfer all responses to the answer sheet at the same time, once you have marked all questions on your exam. Make sure that you have filled the appropriate bubbles carefully in pencil.

 

- Take the time to check your work before you hand in the answer sheet. Trust your instincts and try not to change your original answers.

 

Strategies for Short Answer Questions (Canada)

 

- Bring at least 2 pens.

 

- There are about 30 questions divided by groups and each question has multiple parts. You have 3 hours to answer them. Pace yourself appropriately.

 

- Glance through the questions and answer the easy ones first.

 

- Read the entire question before putting down your answer.

 

- Write legibly. Use bulleted lists and tables.

 

- Provide the number of answers that are asked for. If you provide 5 answers when 3 are asked for, only the first 3 will be marked.

 

- Write down the most important answer first. If a disease has multiple histologic features, write down the most common feature first.

 

- Do not leave any questions unanswered.

 

Strategies for Examining Slides and Images

 

- Make sure your microscope works well before the examination starts.

 

- For the US and Canadian exams, you have about 2 minutes to examine each glass slide, and about 20 seconds to provide your answer and pass the slide to the next candidate.

 

- Both the US and Canadian exams also include screen-based images for showing virtual slides, and gross pathology, forensic, and other images.

 

- Pace yourself appropriately:
- The US exam has a 3.5-hour session for examining about 50 glass slides and 25 virtual slides, and a further 1.75-hour session for screen-based images.
- The Canadian exam has a 2-hour session for examining about 50 glass slides, and a 90-minute session for examining 40 to 60 screen-based images.

 

- Provide 1 answer only to each question unless otherwise specified.

 

- If you cannot make a satisfactory diagnosis, provide the best answer you can, and move on. Do not leave any questions unanswered.

 

- Remember "common things are common" and the answer is most likely straightforward. You do not need to rack your brain looking for "rare birds."

 

- For the Canadian exam, do not write lists of differential diagnoses, and write legibly but quickly.

 

Strategies for Oral Examinations (Canada)

 

- Be professional. Dress professionally and act professionally. Look at the examiners with a level of confidence. You have studied hard and prepared yourself well for this day. Accept that you will be a bit nervous, which is expected and appropriate.

 

- There are 5 to 6 cases to examine in 1 hour. Each case will have 1 or 2 slides with age, gender, and site information. The materials could come from surgical cases, autopsy, or cytology. After reviewing the cases, you will be examined by 2 examiners for 1 hour.

 

- Make notes while looking at the cases: summarize histologic features, differential diagnoses, and diagnosis; note answers to anticipated questions. Take the notes with you into the examination room. You can also make notes during the oral exam to organize your thoughts.

 

- The oral examination usually starts with "describe what you see and give a differential diagnosis," followed by "describe how you would work this case up." Do not jump to the diagnosis right away even if you are confident with your diagnosis. Do not be panic when you cannot get a definitive diagnosis. A structured approach with a differential diagnosis is usually what the examiners are looking for.

 

- Be patient. Wait for the full question to be asked before answering. Think and organize your thoughts before answering. It is fine to ask for clarification or for the question to be repeated if you do not completely understand the question.

 

- Be honest. When you do not know the answer, say, "I do not know," or "I will look it up," or "I will show it to someone else." Do not guess wildly. Do not ramble wildly. You will be interrupted if you ramble.

 

- Be independent. Do not expect feedback or comments on how you did during the exam. Do not be misled by inadvertent feedback, or the behavior or attitude of the examiners.

 

- Take hints from your examiners. If they ask you whether you have anything else on your differential or any other stains you would like to order, it means you are missing something. If they ask whether you are sure, it means you are probably wrong. Do not argue with or question the examiners.

 

AFTER THE EXAM

 

- You have done your best. Do not contact your examiner to see how you did.

 

- In the US, you receive your results through PATHway from the American Board of Pathology.

 

- In Canada, the exam board stratifies candidates into pass, borderline, and fail groups. For all borderline candidates, the exam board reads final in-training evaluations reports (FITER) and considers scores on all components to make the pass/fail decision. Exam results are usually available within 1 week.

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