The course structure has changed a bit since my time, but students still run through a series of clincial rotations whilst also learning clinical pathology. In Cambridge, graduate students have only one year for this, standard medical students have two.
Clinical Rotations TOC
- internal medicine
- surgery
- paediatrics
- obstetrics and gynaecology
- neurology
- orthopaedics
- ophthalmology
- psychiatry
- GP
- rheumatology
- infectious diseases
- haematology
- …
Pathology TOC
- HISTOPATHOLOGY – According to the local definition, this subject which spans pretty much most illnesses in existence (definition, epidemiology, aetiology, pathogenesis, symptoms, microscopic and macroscopic changes, investigations) except huge detail on treatment. As much work as it is go through this, it is a great way to get acquainted with a big chunk of the curriculum as a first round. In the final year, you then just have to focus more on symptoms & signs and add on treatment options.
- CHEMICAL BIOLOGY – a subject that mainly focuses on investigations, but also diseases characterised by a particular measurable imbalance in the body (e.g. hyper/hypocalcaemia).
- MEDICAL MICROBIOLOGY – focuses on microorganisms causing disease, the infectious diseases themselves and their investigation and treatment.
- CLINICAL IMMUNOLOGY – spans diseases relating to autoimmune processes or states of immunodeficiency.
- HAEMATOLOGY – covers diseases of the blood and bone marrow such as polycythaemias and cytopenias, malignant diseases, clotting disorders, transfusion medicine and investigations relating to blood and bone marrow.
- MEDICAL GENETICS – focuses on genetic disorders and their investigation.
How to fit pathology into your rotations – MATCHED APPROACH
This is not easy, but don’t forget it has been done many times before, so you can do it, too!
The solution is to start as early as you can to match your pathology revision with the specialities you are rotation through, to make everything relevant. Below is an example of how I matched things for two specialites, the rest of the course has changed too much since:
PAEDIATRICS
* Histopathology - paediatric (and maternal) pathology, reticulo-endothelial system
* Chemical pathology - (pregnancy,) foetus and neonate, inborn errors of metabolism
* Haematology
* Medical genetics
OBSTETRICS AND GYNAECOLOGY
* Histopathology - female genital pathology, (paediatric and) maternal pathology
How to fit pathology learning into your rotations – ALTERNATIVE APPROACH
Of course, you can just work through each topic one by one - here's an estimate of how long it may take you:
* Histopathology - takes by far the most amount of time, so start early. Plan a few weeks to get through everything.
* Chemical pathology - either work through alongside your histopathology or do in one go. I did the latter and it took me about two weeks to get through it.
* Medical microbiology - Can be a LOT of work if you want to make your own notes from scratch. It did that and it took about two weeks.
* Haematology - Easily fitted into a low-intensity placement such as paeds, but may/will need revisiting as some diseases can be quite complicated (e.g. the lymphomas).
* Clinical immunology - Takes only a few days and there is some overlap with the histopatholgy syllabus.
* Medical genetics - Took me a day or two, so easy to tick off.
Which Books to Use
You will problaby use quite a few books for pathology, here are a few suggestions:
Histopathology - As a starting point and scaffold for each disease named in the syllabus, I highly recommend the Oxford Handbook of Clinical Pathology. If you're the type of person not wanting to make notes, this book can be a substitute. For more detail, I worked mainly with Robbins Basic Pathology, switching to Robbins and Coltran's Pathologic Basis of Disease for the important topics. They are quite wordy textbooks, but I got used to working with them. I also used Xiu Pathology Crash Course but liked and needed it less and less as the year went on. Useful as always is the Oxford Handbook of Clinical Medicine and Kumar and Clark, either as the full or the essentials version.To fill time during commutes, runs or the gym and still learn some path, make sure to get your hands on Goljan's Pathology lectures in audio format. They are excellent, better than any podcast you find on the medportal.
Chemical Pathology - Initially, I found it hard to find the right book for this topic. I started with the Illustrated Colour Text in Clinical Biochemistry, but that was not detailed enough to tick off every point in the syllabus. I then used Marshall Clinical Chemistry and Beckett Lecture Notes in Clinical Biochemistry to expand my knowledge. Even though the overall information is pretty similar in both books, I sometimes found one chapter better in one than the other, so perhaps it's worth getting both out of the library. Towards the end of the year, I bought the Oxford Handbook of Clinical and Laboratory Diagnosis, a book that I wished I had bought earlier in the year, because it is less wordy and neatly lists loads of investigations and links it to their clinical application. It also has a section listing investigations for particular presenting symptoms.
Medical Microbiology - MM was by far the hardest topic for which to find the right book. My advice is to start with the podcasts on Medportal and then expand with the following: Medical Microbiology at a Glance or your pre-clinical pathology notes if you still have them, followed by Lecture Notes in Medical Microbiology and Infection. You should also absolutely include the BNF, even if you don't use any of the books I just mentioned. Make sure you work through the introduction of chapter 5 for the antibiotics part of MM. The Oxford Handbook of Clinical Medicine is of course also in the mix, especially regarding infectious diseases. Finally, use Dr Carmichael's handout from the various symposia and the infectious diseases placement - they are very useful.
Clinical Immunology - For this topic, I had purchased Lecture Notes in Immunology, but found that I did not use it very much. Instead, I used the same books as listed under Histopathology.
Haematology - I started with Haematology at a Glance, which I still recommend, but unfortunately it is not detailed enough. Therefore I've supplemented with Robbins Basic Pathology, sometimes even Robbin and Coltran Pathologic Basis of Disease (e.g. for lymphoma). For brief but good overviews, I used Oxford Handbook of Clinical Pathology. Finally, don't forget the Oxford Handbook of Clinical Medicine.
Medical Genetics - This is the only topic where you don't really need a book, just stick to the lectures and revisit some pre-clinical lectures on genetics and biochemistry.
Revision - For MCQ's, try Robbins and Coltran Review of Pathology. For the practical exam, try Robbins and Coltran Atlas of Pathology in order to become familiar with gross pathological specimen. I think I worked through this entire book and even enjoyed it! There are also useful flashcards with histopathology and cases, again by Robbins or more case-based by Lange. For Clinical Biochemistry revision, I used Murphy Case Studies in Clinical Biochemistry, a book that I enjoyed reading and can only recommend, even though it was perhaps (unfortunately!) less relevant to the actual practical exam. Finally, try to find someone who got a distinction and ask what they did – they will obviously have done a very good job at revising.