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.