Surgery

As a medical student on Surgery clerkship, you will likely be scrubbed in for operations, but most operations would be a good opportunity to see anatomic pathology in vivo. Whether you can see pathology-in-action varies substantially based on what service you are on during the surgery rotation. You can ask the surgical attending for permission. The best time to interact with pathologists is when the surgeon requests a frozen section (aka “frozen” or intraoperative consultation) or a “rapid gross.” Pathology residents or pathologists assistants are paged to the OR, at which point medical students may leave the OR and follow the pathology team member with the specimen to Weinberg 2nd floor to observe the frozen section or rapid gross. Surgeons occasionally all go down to pathology with the attending in particularly challenging cases. For all surgical cases, you should follow-up with the final diagnosis by checking the Pathology reports on EPIC.

1. The surgical oncology services are good for students interested in pathology. Surgical oncology services in general surgery, such as HPB, breast, endocrine, complex abdominal (handelsman GI), colorectal, and thoracic will all have opportunities to check on the pathology after resection. Often times, the surgeon will ask pathology to do a “show and tell,” where they bring the specimen back to the OR for the surgeon to review after pathology does a brief gross dissection. Usually, pathology is checked electronically or discussed at tumor board which varies substantially between the different surgical oncology services listed.
2. Pediatric surgery sends biopsies for frozen during Hirschsprung disease cases to assess for level of pull through. These cases are good ones for medical students to follow a specimen for frozen because the biopsy is critical to the operation in real time. Tumor biopsies are also sent on occasion for pediatric malignancies such as neuroblastoma or Wilms’ tumor.
3. For exposure to anatomy, organ procurements during the Transplant rotation are a great opportunity, as the exposure is unmatched by any other operation that they do.
4. Laparoscopic and robotic cases are also good for medical students.
5. Trauma surgery, Ortho, plastics will have occasional cases where pathology would be educational, but maybe once or twice a rotation.
6. Opportunity to do a virtual surgical pathology or Bayview surgical pathology elective x 3 weeks.

Self-study modules from Baylor integrating high-value care/lab testing with clerkship content