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.