Hm, how to summarize pathology and pathophysiology in a single post. I am tempted to scan the cover of First Aid for the USMLE Step 1 and just say “read this and pray.”

But as unfortunate as it is for many med students, First Aid does not quite have all the answers for how to nail your path material – or, for that matter, your Step 1 exam. It has all the diseases and associations you’re likely to encounter on Step 1, but you’re more likely to memorize the verbiage in your lease or the entire script of The Vagina Monologues than all the text in the path sections of First Aid.

Click here for the full podcast with Michael Babcock, a medical student who got an A on every exam in his second year, and ultimately a 267 on Step 1, to find out how he studied pathology and pathophysiology.

So, inasmuch as your path material will seem endless, I will try to be brief. As with other posts in The Field Guide, I will provide some guiding principles to help cement your path knowledge from whatever sources you use, whether it’s a concise resource like First Aid, a dense textbook like Robbins and Coltran Pathologic Basis of Disease, or anything in between. And if you want to hear from another medical student who is a truly an expert on blowing this material out of the water, check out the podcast here.

1. When possible, know the why. The goal of learning path should be to reduce the rote memorization as much as possible. The best way to do this is to actually explain the signs and symptoms of a disease rather than as isolated facts or associations. It’s a bit more work up front, but trust me, once you’ve explained a disease process to yourself, you won’t forget it.

Podcast: a study strategy for acing pathology and pathophysiology. It might surprise you.

I’ll use an example condition to illustrate: aortic insufficiency. In this condition, the aorta is leaky, so blood flows backward from your aorta back into your heart. One fun fact you’ll learn about aortic insufficiency is that it’s associated with a “widened pulse pressure,” which means that the systolic blood pressure increases while the diastolic blood pressure decreases. In other words, a normal person is at 120/80, but someone with aortic insufficiency might shift to 140/60. You could simply memorize this association.

Podcast: study method.

Or…

You explain it. In aortic insufficiency, blood is flowing backward through a leaky aorta during the period when the heart isn’t contracting, known as diastole. This means you won’t have as much pressure during diastole – i.e., diastolic blood pressure is down. OK, explained half of it. As we approach systole (when the heart contracts), there is now more blood in the left ventricle than you’d expect; in addition to the normal blood filling the ventricle in a forward direction, you also have additional blood backing up through the leaky aorta. This excess blood volume stretches the left ventricular muscle, which, as you know from first-year physiology, makes its subsequent force of contraction greater. So during systole, you have an increased pressure. Systolic pressure is up. Diastolic pressure is down. Widened pulse pressure. Voila!

Podcast: the utility of online resources like UpToDate.

Read that explanation twice, and I bet you won’t forget it. It also illustrates another dirty little secret of med school: you don’t have to be all that smart to understand most concepts. What I just explained has probably been similarly described by a plumber about a leaky toilet.

Which brings me to my next tip, about the #1 resource that breaks down pathology and pathophysiology into simple terms.

2. Use Pathoma. Many med students rely on this resource exclusively to learn path. Others use it as a supplement to their lectures, textbooks, First Aid, etc. I won’t tell you how hard to lean on it, but it should be somewhere your up your pristine white-coat sleeve. (Or, if you’re like me as a second year, your stained-by-coffee-and-marinara-sauce-that-may-be-mistaken-for-blood white-coat sleeve.)

Podcast: the pros and cons of Pathoma.

Authored by Dr. Hussain Sattar, Pathoma is essentially a set of videos (about 35 hours total) with complementary text that covers the major pathology + pathophysiology you’ll need to know in your second year – or at least for your Step 1 exam. Better yet, it explains the why and does so very simply. Dr. Sattar also frequently gives a brief overview of the normal physiology as a lead-in to explaining the subsequent pathophysiology, which is a great way to neatly tie together your learning.

It’s not exhaustive, which is why some students seek additional supplementary sources, including Boards and Beyond, Doctors in Training, and videos from Khan Academy. But when it comes to achieving efficiency plus understanding in your path studying, it’s hard to beat Pathoma.

3. If there’s one thing to really understand in histopathology, it’s cancer. Fortunately, knowing what diseases look like microscopically isn’t the most high-yield material you’ll learn – but it’s definitely high on the list. And if histology wasn’t your thing as a first year, then histopathology can be intimidating. If you don’t know what normal looks like, it’s hard to learn abnormal. And, although I know you’re pining for more purple-and-pink coloring books, now is not the time to try and relearn histo.

Podcast: the relevance of physiology and histology in mastering path/pathophys.

If this describes you, then my advice is to try and at least understand the defining features of neoplasia (i.e., cancer). Of everything you learn in histopathology, these principles will come up again and again in various contexts. Understand terms like pleomorphism, mitotic figures, hyperchromatic, and dysplasia, and know what they look like on a microscopic slide. Know how to recognize a metastatic versus a benign biopsy.

Much of the rest of histopathology is about recognizing a key pathological feature, and you don’t necessarily need to be a histology whiz for this. In fact, you can often get away with knowing the buzzword and a single image that depicts it (for instance, a “teardrop” red blood cell looks like a teardrop and signifies bone marrow fibrosis).

Gee whiz, that leads me to my final tip. It’s almost like I planned it this way.

4. When all else fails, learn the buzzwords. Unfortunately, there’s quite a bit in your second year where you either can’t know the why or it’s not worth your time. Note that “it’s not worth your time” is a slippery slope, and for many pathophysiological mechanisms, you should make it worth your time so you don’t overload your brain with unsorted info.

Podcast: the most difficult-to-learn concepts.

But perhaps more than in any other course, there are moments in path where you just have to furiously rub your eyelids and learn random facts and associations. Autosomal dominant polycystic kidney disease links to berry aneurysm. Parasitic infection with schistosoma haematobium links to squamous cell carcinoma. The 4 F’s of gallstones (Fat, Female, Forty, Fertile). By the end of this course, even if you feel completely unqualified to take care of patients, you’ll definitely believe you could win Medical Jeopardy.

By this point in your training, you should be a pro at fact memorization. Whatever technique you’ve worked out should suffice here, too. But it’s important to minimize this technique as much as possible by utilizing the tips above.

Click here for the full pathology/pathophysiology podcast

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