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A Mayo Clinic podcast for laboratory professionals, physicians, and students, hosted by Justin Kreuter, M.D., assistant professor of laboratory medicine and pathology at Mayo Clinic, featuring educational topics and insightful takeaways to apply in your practice.
This is Lab Medicine
Rounds, a curated podcast
for physicians, laboratory
professionals and students.
I'm your host, Justin Kreuter,
the Bow Tie Band of Blood
a transfusion medicine
pathologist at Mayo Clinic.
Today we're rounding with Dr.
Clarissa Jordan, chief
resident in anatomic
and clinical pathology in the Department
of Laboratory Medicine Pathology here
at Mayo Clinic to talk about
online pathology resources.
A timely topic as we're getting
into the new academic year
for those that are learning
pathology and always
nice for those of us
that are practicing to
understand what are those
valuable resources out there.
Thanks for joining us today
Dr. Jordan.
Thank you so much for having me.
I'm really excited to talk
about this with you today.
So maybe to kick things off,
I'm curious, how have you gone
about learning, discovering
what you kind of use
as the online pathology resources?
Absolutely. You know, as, as far as those
of us who are in training
programs and who are, are
you know, current learners,
I think the best resource
for me really has just been
talking with other residents,
particularly residents who, you
know, are, are further along
in their training and have
more experience than me.
You know, I, I think it's
useful also to talk to a variety
of these residents because
different people have
have different preferences
and might like different things.
Some resources may be
more kind of conducive
to your learning style, for example.
So I always advise residents to
to kind of ask around,
see what's out there.
I think another great
place is Twitter, actually.
I think you can find a ton
of great pathology resources
you know, directly on Twitter
or just by asking people.
I've noticed a couple of great threads
particularly after board
season where people talk
about what was most useful.
So yeah, that's sort of
been the two main areas
that have really helped me find
online pathology resources.
Oh, gotcha.
And I'm glad you're kind of
highlighting this, you know
getting the variety and
and how Twitter can really help with that.
Do you find also with that variety
as you go to different rotations
that you kind of pick up some resources?
Or is it, is it more of, like
you say, when somebody puts
out a bolus, kind of
after taking the boards
kind of highlighting what
did, what do they find useful?
Yeah, I, I think for,
for me at least, it's
it's sort of been rotation dependent.
Whenever I'm about to head
onto a new rotation, I'd
like to, you know, message
or just talk to residents
who have maybe even just gone
through that rotation to see, hey
what was most useful to you?
You know, in terms of
textbooks or, or again
online resources as we're discussing.
I think that kind
of peer to peer learning is,
is really super valuable.
Absolutely. And I'm always
curious to learn what
are people talking about?
Because I, I think that's really,
that kind of, you know
learner perspective is really
important and probably for
I guess, how you use
those resources, right?
Because sometimes things are almost
like you have to be an
expert to understand.
So it makes me curious
how are you using these online resources
in your practice or to
augment your, your learning?
I imagine there's a, a little bit of both.
Can you kind of elaborate
a little bit for us?
Yeah, sure thing.
And I, I think you make
an excellent point about
you know, sometimes
it's, it's about figuring
out what resources are
gonna work for you in
in which specific scenarios.
So I'll give a couple different examples.
So for anatomic pathology, I think a lot
of people are familiar with a
website called Kurt's Notes.
This is Dr.
Kurt Schaberg, who is
at UC Davis, I believe.
He has really put together
kind of these quick
reference guides, almost
you could say, for every
pretty much every different organ system
which are super useful.
So I kind of use them
in two different ways.
I, I reference Kurt's notes a lot
during each AP rotation that I do.
So if I'm on a GYN rotation,
I make great use of his
you know, uterus, ovarian,
you know, et cetera guides.
And, you know, for me,
I just find that when
I'm making a diagnosis,
it's a really quick and
easy reference that's easily
accessible from, from anywhere.
I think, you know, in anatomic
pathology especially, part
of the issue is just that
sometimes you may not
even know like what your
options are for a diagnosis.
Right. And I think having
kind of a, a nice condense
and really easy to navigate
resource like Kurt's Notes is
has been really useful
for kind of, you know
providing a framework for me and just
just knowing what's out there
in a specific organ system.
And in addition to, you know,
using Kurt's notes when I'm
you know, on a rotation
making diagnoses and sort of
I guess you could say in clinical practice
I also use it a lot when
I'm just studying on my own.
You know, again, I think
that framework is
something I really try to
incorporate when I'm making
my own study materials and
and flashcards and things like that.
So I, I think these online
resources are really
valuable kind of in,
in multiple modalities.
And do you think kind of
your experience has been
as I really, you know, in in
the medical education world
we talk a lot scaffolding, right?
So that we can really kind of
make the most of the material.
As you're saying, you kind of set
up this framework when you're
using an online resource
like that.
Do you think that that allows
your face-to-face learning
with your attending physician to
does that help you kinda ask
more interesting questions
or do you feel
like you get more out
of the experience when
you've kind of done that kind of prep?
Does that kind of lean
over into that experience?
Yeah, absolutely.
I think, you know, whenever
I'm looking at a
a tumor for example, right?
I always want to, well
even backing up a little
further from that, right?
The first thing you wanna
decide on when you're looking
at a piece of tissue is, Hey,
is this benign or malignant?
I find it really, you know
nice to kind of just go into,
into different categories.
You know, once you
once you are at like the
malignant stage, for example
so like in the ovary, right?
Are we at a epithelial lesion?
Okay. So if I decide, yes, we are
then I know my options are,
you know, Cyrus Endometrioid
clear cell, brener,
you know, so I, I think
I think that's, I, I think
having that kind of framework
in mind is really useful when
you're talking to attendings.
Because then, you know, number one
of course it helps your diagnostic skill
and number two, it demonstrates
that you're really thoughtfully
thinking about the case.
Mm.
I like that too, right?
That's highlighting that,
that I guess I think
of that sometimes as ownership, right?
Yeah. If somebody is taking
ownership for the case
which sometimes is a hard
thing for us in pathology to do
or at least we don't
that way traditionally
it can be thought of.
Are there, I'm curious, you
you talked about the
framework being helpful.
If we kind of back up for a second
and think about that concept
of what's helpful or useful.
Are there aspects of online
resources as you think
through a couple of the tools
that you have found helpful?
Are there some common themes
about them that make
them more useful for you?
Yeah, absolutely.
I think one resource
that I really like that
I've been using Mora
on my CP rotations is gonna
be the AACC learning lab.
So that's from the American Association
for Clinical Chemistry
and the New England Journal of Medicine.
It covers more than
just clinical chemistry
it covers a lot of clinical
pathology topics like heempath,
transfusion as you know,
genomics, immunology
even laboratory management.
And, you know, one of
the things I really like
about this particular resource is
that it uses adaptive learning.
So for example, you know
it'll ask you questions kind of upfront
about the material and then based
on how you answer them and
how confident you report being
in your answer, the
curriculum actually adapts.
So if you got a question wrong
or maybe you got it right
but you weren't very
confident about it, you know
the curriculum will go more
in depth into that particular topic.
So I, I think that's, you
know, I know you and I, Dr.
Kreuter are both really passionate
about education strategies
and kind of best practices
on how to engage learners.
And so I, I think this
approach is really awesome
and it incorporates, you know
active recall space, repetition,
those things that we love.
So that's, you know, I
think that's just an example
of a really well done resource.
I think also online
resources that take advantage
of kind of the new big
revolution in pathology
digital pathology are really awesome.
So for example, there's kind of a
a newer textbook called
Surgical Pathology Reimagined
and that's from Ace the Boards.
And what I love about this textbook is
that there are QR codes, so
you can actually scan those
and then it'll take you to a
digital slide that's online
which I think is just super
useful because, you know
photos in a textbook can
only show you so much, right?
Like, it's gonna show you
just usually a small part
of the slide and with like
the very best features of,
of whatever the entity is.
And I think providing a
whole slide image kind of
in contrast to that is like, you know
it helps bridge the gap
between like textbook picture
and actual clinical practice.
So yeah, I, I think those
are two great examples.
I'd love to kind of pick into this.
I'm, I'm curious for your thoughts
as you talk about the, the
slide, and I may be totally off
so feel free to let me know.
I, you know, I think about
like somebody who's, you know
in their first year
just learning like maybe
like the slide feels
like you know, the ocean.
Yeah. And in that context
like maybe that kind of,
you know, directed pointed
and this is the feature is
helpful, whereas in contrast
somebody very senior like
yourself, like, you know
getting ex getting that,
that ocean, that full slide
in front of you and where
you're just like, yeah, this is
this is where it's at.
Do, do you hear anything amongst like the
the other residents as
people are developing?
Do they have or are there features
that the digital pathology is able to turn
on that can direct more novice learners?
Absolutely. I think, you know
as more institutions are kind
of embracing digital pathology
and kind of curating these
digital slide study sets
for their residents
I think something that
I've noticed that's useful
from kind of our study
sets is to have consultant
or attending pathologists
really annotate the images
so that you can kind of have that zoomed
in. Like, Hey, this is
what you're looking for
especially for those junior
residents as you, you know
astutely point out, I think it's
it's great for more senior
residents to kind of
have that blank slate
approach where it's like, okay
this is me out in clinical
practice, I get this slide.
I need to be able to have
that skill to really parse
down exactly what I'm looking for
on this slide where not everything
is gonna be maybe useful
to me in making the diagnosis.
So I think that's a
very astute point and I
I do think digital pathology is, has
has some great opportunities
to kind of cater
to both ends of kind of
the learning spectrum.
That's awesome.
A as we're kind of talking
about this at both ends now
I know we've been name
dropping some resources and Dr.
Jordan's kindly we're sharing
that in the show notes today.
And we're not gonna name names here
but I think there are examples.
I mean, I've been asked to look
at some learning materials.
I think there's a lot of us, fortunately
that are passionate about
teaching our specialty and
you know, have you seen
examples where, you know
somebody certainly is passionate
but it's just that website
that they're developing
it's just not useful for whatever reason.
I think if that's the case
I think it'd probably be really helpful
for people to kind of hear, you know, as a
as a senior learner, you
know, junior colleague
what's your perception
on maybe some things that actually impede
or not useful that, that
you've seen people use?
Yeah, I can think of maybe
a couple different examples.
You know, I, there's,
there's certainly a lot
of question banks out there for pathology
and more specifically I
think for board studying
I find them still useful even, you know
before I was, you know, boards prepping.
I will say though that, you know
some question banks are, you
know, better than others.
I think some incorporate a lot
of negative questions,
which, you know, for example
all of the following except what is true.
And I find those questions
really confusing as a learner.
You know, I, I just think, I
I think in the education
community we've kind of seen
that this is, you know
not the best practice for
learners, but in addition
just adding on my personal
experience, right?
If you are kind of
including a wrong answer
in those answer choices,
I find that to be very
confusing when you're like maybe reviewing
reviewing again, you, you
know that question, right?
I make a lot of flashcards for example.
And so I might want to have
like a multiple choice question
on my flashcard, but I
find it really actually
detrimental to include those
negative questions again
because you don't wanna have
that like incorrect piece
of information just kind of
floating around in your memory.
That's a brilliant insight.
I just wanted to kind of underline
that for our, our listeners,
for those of us that
that write board questions
and also select questions
on the rise exam.
Know that that negative
question is, is a no-no
but I could see where
people that haven't had
that experience yet may
not be aware of that.
And I think it's a
brilliant insight and, and
and highlights really where it
is an impedance to learning.
So thanks for sharing that.
Absolutely. I think another area that I
I personally find to
be maybe a little less
useful is when people
are sharing things online
but they kind of don't share the answer.
And sorry, this might have
to be like, edited a bit
and this is maybe a little
more of a half-baked idea
but just FYI, so for example
when folks will share a slide or an image
and then they'll say, Hey, come back
in a week and we'll
discuss the answer For me
I really love kind of that
on the spot learning, right?
I think active recall is as we know
a really important learning
strategy for me, I think it's
as a learner, I think
it's most useful to yeah
challenge yourself, do that
act of recall in the moment
but then turn around and,
and, and get the answer right.
I think that's where you can
really solidify your learning.
So I think some learning
resources which maybe
don't provide you with
an answer or an ease or
or a way to find the
answer kind of on the spot
I think a lot of the learning can
can really slip through the
cracks in in those times.
I, I really like that because I know
of examples that have been
successful of people doing that
but as I think about
that, I think the users
of that are really the
professional community as far
as what I've seen Sure.
Ra rather than the learners or the
the larger community of pathologists.
So again, that's another
brilliant insight.
Thank
You. Thank you.
One of the nice things too is
that you are also involved
in curating content online.
So just to give a shout
out for your own website
pathcejmd.com.
So for our listeners check out
of course we'll put the links
in the show notes to that as well.
But could you tell us
how have you approached
sharing content on your
website from the standpoint of
you know, how do you
kind of put it together
and has that process
changed over the years?
Yeah, sure thing.
You know, I think I first
started sharing pathology
education content online when
I realized I was creating kind
of notes and educational
materials for myself.
And I thought, well, you know
this might be useful for someone else
so I'll just share
it and see what sticks.
And then since then I've
I've tried to be a little more intentional
about what I really want
to accomplish with this.
And so I kind of sat down
with myself and thought about,
you know, goals for this.
And so I
I want to make content
that's, I think I decided I
I want to make content that's
clearly understandable
thoughtfully organized
and clinically relevant.
And I know that's like a really lofty goal
but essentially what
that boils down to is I
I really wanna be focused on the needs
of the learner kind of in that moment.
So as we've kind of alluded to already
just something that's really
easily digestible in the moment
and just gives you kind
of the salient points.
You know, I'm sharing cases
that I've kind of come
across in practice which are,
are de-identified of course.
And you know, not from
the same time period
like the current time period,
but basically, you know
I try to approach this by
thinking about, you know
what are kind of the practical
and salient points that
I learned from this case.
You know, I'm not trying to be a textbook
I'm not trying to be a
comprehensive resource.
I think other people do
that much better than me
but I'm just trying to think,
okay, what would be useful
or what did I learn and
what would be useful
to other learners when they
may come across this entity?
So let's say usual doctor
hypo usual ductal hyperplasia
in the breast, for example, right?
Let's say I saw a case of that
I might think to myself, Hey
what are the key features
that I recognized
or I learned about when I was signing
out with the attending that
I think would be useful?
So then I'll often
annotate images like, Hey
these cells have like a
nice streaming quality
that's really good for UDH or, or
I see these peripheral
irregular fenestrated spaces
that's also great for, for UDH.
So I, I love annotating images.
I think that's super useful.
I also think what makes part of, you know
posting educational
content online fun is when
you get to engage with folks.
So then I often think of kind of questions
or polls that might be that
I could add in to the case.
Again, it kind of gets
people engaged a little more.
It's great for boards prep.
It allows you to get kind of maybe more
at like a, a higher order
like a second or third order
level concept related to the
the point you're trying to make.
Right? Like you could say, which
of the following IHC stains
is positive in, you know
this entity and just have
a photo of it, right?
So that way, you know,
you gotta number one
know what the diagnosis
is and then you gotta
know your IHC stains
kind of on top of that.
So it gets at a kind of a
higher order than just, Hey
what is this diagnosis?
And again, I often
like to give, well I
always like to give the answer
kind of on the same page.
Again, I think, you know,
challenge yourself, right?
Do that active recall,
that's super important
but then, you know,
check your knowledge and
and solidify your
knowledge in that moment.
I think for, for busy
residents, I think that's
that's super important and
and just a strategy that I've
found to be successful for me.
Well, certainly one of my
failures in life has been
that I haven't been able to recruit you
into transfusion medicine
fellowship, but I think Thank you.
You know, you're really highlighting
for the audience that I
think is phenomenal is
that you are thinking very
deeply about this material
about what you're learning.
So like already
like some people may see
you doing this work and it's
it's a gift that you are sharing for sure
but it's also benefiting you, right?
Is the, the deep thought
that you have to put
in to think about what is a
relevant question as well as one
of the unique things, and
this is kind of hat tip to you
and all of the other learners
to think about is because I know
that imposter syndrome is a
real struggle, that you know
your perspective on what is the
what did I learn from
this is supremely valuable
in a way that somebody
who is a world expert
in something writing a
board review book probably
is not capturing and, and presenting.
Yeah, absolutely.
First of all, thank you
for your kind words and
I totally agree with you.
I think having that kind
of learner perspective on
things is really important.
You know, I would encourage
other folks to, you know
do this if, if they want, like
you were kind of alluding to
I think, you know, I've learned so much
from posting educational
content online, you know
the entities that I know best are, are
are often the ones that I
I post online just for that reason.
Right? I have to really think
deeply about it and yeah
I know it can be intimidating, you know
alluding to the imposter
syndrome that you mentioned.
But no, I think
it's a great research.
It it, you know, these
this can certainly be a
great resource for everyone.
Absolutely. We've been routing with Dr.
Jordan talking about
online pathology resources.
Thank you so much for sharing some
of your recommendations as well
as taking the time to talk
about this with us today.
Thank you so much.
I had a lot of fun.
To all of our listeners, thank
you for joining us today.
We invite you to share your thoughts
and suggestions via email
to MCLeducation@mayo.edu.
And if you've enjoyed this podcast
please subscribe and until
our next rounds together
we encourage you to continue
to connect lab medicine
and the clinical practice
through insightful conversations.