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Re: OJ:纽约病理和内科实习点滴(之一)——法拉盛生活资料小
[版面:医学职业][首篇作者:USMedEdu] , 2016年04月29日23:45:18 ,50558次阅读,404次回复
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USMedEdu
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: OJ:纽约病理和内科实习点滴(之一)——法拉盛生活资料小
发信站: BBS 未名空间站 (Sun Feb 19 01:33:17 2017, 美东)

医网情深:十年里那些让我难忘的同学(6)--走在考版和住院医道路上坚强的宝妈们

力刀


今天送走了今年新年从加州飞来纽约实习的一位女同学,一个娃娃才两岁多的宝妈。

一个多月内科和病理的紧张强化实习,让在家养娃没有怎么工作的她从刚来时的一脸茫
然不知所以,对美国临床没有任何感性认识变得与诊所和实验室工作人员成为熟人和朋
友,熟悉了一些临床基本情况、对今后的专业选择也有了初步的认识、对一些可能遇到
的困难也有所了解。

带她去医院、去诊所和实验室、去机场的路上,除了专业的不断强化训练,也天南海北
的聊,闲聊中加强有关面试的应对。听着她每周、每天的新鲜感受和趣闻趣事,给她指
出一些看似普通的小事,对于她今后写申请、PS、甚至进入面试时的意义和重要性。

纽约,寒风凛冽,吃过热辣的火锅,驱车前往机场。车上,赠送她正式印制的精美带钢
印的实习证书、一份珍贵的礼物——有着高耀洁医生的亲笔签名版《镜头下的真相》,
关于河南农村农民因献血卖血感染HIV的纪实。希望她今后能成为象高老师那样的一个
具有博爱之心的好医生。

机场起飞入口处,分别时,握手、hug、道别。她说“我争取进到纽约的单位、就还来
看你……“,说着眼睛红了……。我转身离去,上车,还听到她关心地喊着:刀医生,
注意休息、开车注意安全……

她,不是第一个,当然不是最后一个,从加州、或其他外州来实习的宝妈同学。新年初
,得到两位去年暑期带教的宝妈同学电子邮件告知——其中一位也是来自加州,都得到
了面试,一位新年刚过,还得到了面试单位主任的热情来信问候。

培训她们的同时,其实也是自我提高和更深刻理解作为一个初级培训教师的意义。我的
母亲是一个教了一辈子小学生的小学老师,也是我和弟弟的启蒙老师、从母亲那里,我
耳濡目睹作为小学老师的影响和熏陶对于一个孩童成长、和发展的重要作用。

我成为不了教授、大牌专家,就做一个力所能及的“小学教师“,为没有入门的医学生
同学们做点启蒙、指点入门的小事吧。尤其是看到这些勇敢、坚强的宝妈同学义无反顾
地选择了拼搏走上住院医生的道路,更有了一种责任和义务感。无论她们今后是否还会
记得我,联系我,是否成为大牌医生和专家,带教的过程我已经感到非常的满足:满足
于这种教学的过程。

人生过程的一种体验——象我的母亲那样,此生为一个平凡的小学教师……


2/13/2017 于美国纽约刀客聊斋
美国病理会诊中心: http:ampathology.com
美中医学教育网/网络老刀会: https://www.mitbbs.com/pc/
pcmanage.php?userid=
USMedEdu/





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USMedEdu
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: 医网情深:那些走在考版和住院医道路上坚强的宝妈们
发信站: BBS 未名空间站 (Sun Feb 19 11:42:44 2017, 美东)


【 在 USMedEdu (US_CMGs) 的大作中提到:

今天带国内专程飞来的OJ的实习教学:外科手术切除组织的处理(grossing)、冰冻切
片(frozen section)、不同软件签发报告(sign-out)……OJ手很巧,第一次切片就切
的很好👌,初步学会了两种软件签发报告。工作勤奋努力,文笔流畅精准快捷
地完成我布置的家庭作业:翻译肿瘤病理的文献三篇、写实习感想、提供资讯……一个
好苗子!

--
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USMedEdu
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[回复] [回信给作者] [本篇全文] [本讨论区] [修改] [删除] [转寄] [转贴] [收藏] [举报] [ 15 ]

发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: 医网情深:那些走在考版和住院医道路上坚强的宝妈们
发信站: BBS 未名空间站 (Tue Feb 28 11:00:16 2017, 美东)


【 在 USMedEdu (US_CMGs) 的大作中提到: 】
: 今天带国内专程飞来的OJ的实习教学:外科手术切除组织的处理(grossing)、冰冻切
: 片(frozen section)、不同软件签发报告(sign-out)……OJ手很巧,第一次切片就切
: 的很好👌,初步学会了两种软件签发报告。工作勤奋努力,文笔流畅精准快捷
: 地完成我布置的家庭作业:翻译肿瘤病理的文献三篇、写实习感想、提供资讯……一个
: 好苗子!


OJ是新年后来自国内的医学毕业生,为进入美国住院医生进行为期三个月的内科和病理
实习。工作认真细致、勤奋主动、英语口语和笔译进步飞快,笔耕不辍,已完成数篇布
置的家庭作业——病理和肿瘤内科的新进展文献翻译。这是他的第二篇作业……


2016 泌尿病理新进展

Dr. Debra Zynger, M.D. / OJ 翻译、力刀审校编辑

http://www.pathologyoutlines.com/site/whatsnewinGU.html

世界卫生组织关于泌尿和男性生殖系统肿瘤的分类发布了新版本(第四版),值此机会
综述泌尿生殖外科病理学中的新进展。大多数是疾病诊断名的修订和改变。与病理日常
工作相关的重点如下:

前列腺:

前列腺高度异变上皮内瘤(HGPIN)是唯一一个被认可的前列腺上皮内瘤变,而且只有
HGPIM应当签发报告。(也即不须报告前列腺低度异变上皮内瘤变。)

Gleason评分特订用4和10倍物镜观察评分。这可以减少因水平切面导致的将Gleason 3
级过度诊断为Gleason 4级。

因为Gleason 1和2级很少使用,同时Gleason评分3+4和4+3的总和都是7,但它们的生物
特性却不一样,所以现在建立新的分组系统。Gleason评分和分组系统可以一起报告:

1组:Gleason评分≤6
2组:Gleason评分3+4=7
3组:Gleason评分4+3=7
4组:Gleason评分4+4=8,3+5=8,5+3=8
5组:Gleason评分4+5=9,5+4=9,5+5=10

前列腺腺癌的变异型一直有变。嫌色细胞癌变异型和淋巴上皮瘤样变异型被剔除,添加
了异形巨细胞和微小囊性变异型。

管内癌是一个新的疾病诊断名。它是管内充满了明显恶性的实体或奶酪样肿瘤,但仍有
基底层细胞围绕。勿与前列腺高度异变上皮内瘤(HGPIN)混淆。

类癌更名为分化良好的神经内分泌瘤。小细胞癌更名为小细胞神经内分泌癌。大细胞神
经内分泌癌是新的疾病诊断名。

肾脏:

肾透明细胞癌和肾乳头状细胞癌的分级采用WHO/国际泌尿病理协会(ISUP)基于核仁突
出性的分级系统,放弃了相似的Fuhrman分级方案。

多房囊性肾细胞癌更名为低度恶性多房囊性肾肿瘤。这些肿瘤细胞类似于肾透明细胞癌
但是却在纤维囊内生长且不会扩展。

伴有肾癌的遗传性平滑肌瘤病和肾细胞癌综合征是新的疾病诊断名。这些病人的族系在
编码延胡索酸水合酶的FH基因有突变,具有皮肤和子宫平滑肌瘤。肾肿瘤呈乳头样生长
,核仁突出且被周围透亮圈环绕。这些病人的免疫组化中测不到FH基因,可测到2-琥珀
酰半胱氨酸。

Bellini集合管癌更名为集合管癌。

Xp11易位癌更名为MiT家族易位肾细胞癌,包含了TFE3易位肿瘤和TFEB肿瘤。

琥珀盐酸脱氢酶缺乏肾细胞癌是新的疾病诊断名。病人在SDH基因,通常是SDHB,有变
异。嗜铬细胞瘤/副神经节瘤也有类似情况。肾肿瘤呈实心生长,细胞形态均匀一致,
都有胞质呈毛玻璃或颗粒状的嗜酸性空泡。SDHB的免疫组化呈阴性,而所陷在肿瘤细胞
内的肥大细胞呈阳性。

可见众多小管和囊的肾小管囊性肾细胞癌是肾细胞癌的另一类型。由于获得了染色体7
和17,丢失了Y染色体,此病有可能与肾乳头状细胞癌相关。

后天性囊性病相关肾细胞癌为新近所命名的新类型,它与透析相关。细胞内有像筛样的
胞质内腔和草酸钙结晶。

肾乳头状透明细胞癌是新的疾病诊断名,也是最重要的一个,其相对常见。小管结构为
排列的细胞核呈现核上或者核下空泡。清晰的细胞浆和肾透明细胞癌相似。免疫组化结
果为CK7,CAIX阳性,CD10,AMACR为局部阳性或者阴性。

乳头样腺瘤的上限从≤0.5cm调整为≤1.5cm。

囊性肾瘤分为儿童囊性肾瘤和成人囊性肾瘤。儿童囊性肾瘤包含了DICER突变,成人囊
性肾瘤则没有。

类癌更名为分化良好的神经内分泌肿瘤。神经内分泌癌拆分为小细胞神经内分泌癌和大
细胞神经内分泌癌。

膀胱(尿道上皮)

“尿道上皮增生”更名为“不确定恶性的尿道上皮增生”。这个病变和增厚的尿道上皮
一样显示出少量的不典型,并没有真正的乳头体,偶尔有上皮的突起。这是之前低分化
的非浸润性尿道上皮乳头状癌的表现。

腺癌的印戒细胞和透明细胞变异型被剔除。

在膀胱内,透明细胞腺癌更名为透明细胞癌。而在前列腺,仍然叫做透明细胞腺癌。

类癌瘤更名为分化良好的神经内分泌肿瘤。小细胞癌更名为小细胞神经内分泌癌。增加
了大细胞神经内分泌癌这一新的疾病诊断名。


睾丸

管内生殖细胞瘤更名为原位生殖细胞瘤(GCNIS)。因为这些瘤内细胞在精原细胞龛生
长,并不在管内增生。在管内增生的包含了管内精原细胞瘤和管内胚胎癌。

青春期后卵黄囊肿瘤和畸胎瘤现在分别称为卵黄囊肿瘤,青春期后型和畸胎瘤,青春期
后型。

除了胎盘部位滋养细胞肿瘤,真性的非绒毛膜癌滋养细胞肿瘤 现在包括了上皮滋养细
胞肿瘤和囊性滋养细胞肿瘤。这些病变在癌转移和化疗后十分常见。青春期前畸胎瘤,
混合型畸胎瘤和卵黄囊肿瘤现在需加上后缀“青春期前型”。这些青春期前的肿瘤无染
色体12p的扩增。

精母细胞性精原细胞瘤改名为精母细胞性肿瘤。它和精原细胞瘤没有关系。

管内大细胞透明化滋养细胞瘤现在是一个疾病的诊断名。

在附睾肿瘤中,“良性间皮瘤”分类被去除,“囊性间皮瘤”病名被删去。


Dr. Debra Zynger,MD,是俄亥俄大学的副教授同时也是泌尿生殖病理部门的主任。在
斯坦福大学取得了遗传硕士学位,在印第安纳大学取得医学博士学位。Dr. Debra
Zynger在西北大学病理系完成解剖和临床病理住院医师培训,在匹兹堡大学完成泌尿生
殖病理专科培训。Dr. Debra Zynger,著有2本泌尿生殖病理教科书,发表了超过60篇
期刊文章,为28家杂志做同行审议也在多家出版委员会任职。Dr. Debra Zynger在众多
国家级会议上发言,目前也是美国病理协会在俄亥俄的代表主任。


2/17/2017 于美国纽约
美国病理会诊中心/美中医学教育网/网络老刀会


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USMedEdu
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: TLL的纽约病理/内科实习笔记
发信站: BBS 未名空间站 (Wed Mar  1 17:15:56 2017, 美东)

发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: TLL的纽约病理/内科实习笔记
发信站: BBS 未名空间站 (Wed Mar  1 17:06:52 2017, 美东)

TLL的纽约病理/内科实习笔记

老刀附言:TLL,一个从西海岸LA飞到纽约,娃娃才两岁的宝妈,
最近结束1个月余的内科/病理实习。写出了她的实习笔记报告。
我看了很是感动。可以说,她,尽管不是资质最好的,但可以说是
我10年里培训过的CMGs里最认真、细致和负责地写出实习总结经验
和体会的。先帝曾有名言:世界上怕就怕认真二字……,TLL就最认
真地进行了实习总结和为自己同时也为更多的在努力走考版进美国
住院医生道路艰苦奋斗的同学们提供了自我学习经验。是一个很好
的学员,这样认真学习和勤奋努力的同学没有道理进不去!我也很
高兴和骄傲有这样的学员!



实习随感:Notes for IM/Path Hands-on Externship

阅读: 120  & 分享: 16

By LeiLei TENG



Basic Information
Location: New York
Specialties: Internal Medicine, Pathology
No. of centers: 2 Gastroenterology Clinics
- 1 Community Hospital Pathology Lab.
- 1 Diagnostics Lab.
Study Duration: 01/08 ~ 02/09/2017
            
Mentor: Dr. He, Dr. Khorshidi, Dr. Jing, Dr. Yan  
Objectives
- Learn and understand US Medical Culture
- Get an actual impression of Internal Medicine and Pathology work mode in
both academic and private practice settings.
- Do a better mapping of the Match and also Myself
- Practice Clinical Interview Skills and prepare for step 2 CS
- Build connections and get Letters of Recommendation
Methodology
- Internal Medicine
  Interviews: observe and practice interviewing Pts.
  EGD/Colonoscopy: observed procedures; entered procedure notes
  Follow-up telephone calls
  Courses
  HP breathing test on Pts.

- Pathology
  Reading pathology slides
  Grossing
  Courses
  Conference
IM: Observation Case 1
- 19-year-old male c/o new and worsening ab pain.
- Pt referred by PCP as blood test results showed “Elevated LFTs”.
- Occupation is Pizza deliverer.

Take-home message:
- There are Five main reasons which can cause the High LFTs: Infection,
Inflammation, Metabolism, Immunization, Structure.
- Work-up of High LFTs including Blood test looking for any infection,
inflammation, metabolism or immunization attack to the liver, also U/S
looking for any abnormal structure.
IM: Observation Case 2
- 39-year-old male c/o bothersome Bloating and Gas, moderate and
intermittent. Accompanied by frequent urgency for bowel movements, but very
little feces comes out.
- Pt is S/P EGD (1 month ago, H. Pylori positive and on H.P. eradication Rx)
- Impression is “Temporary Irritable Bowel Syndrome”. Rx: Simethicone,
Metamucil and Probiotics

Take-home message:
- IBS is a functional disorder, can be temporary.
- Probiotics and gas-reduced Diet improve IBS (I also had similar symptoms
at that time, and get better after change my diet and taking Yogurt which
contain probiotic.)
IM: Interviews - My First Interview
-  49 yrs African-American male referred by PCP for screening Colonoscopy.
-  Pt denied any symptoms. No previous EGD or Colonoscopy. No fever, weight
changs or fatigue. CBC 1 month ago showed “anemia”.
-  Allergies: Itchy skin after eating certain kinds of fruits.
-  PMH: Pt stated “blood clot” in the brain which was removed by surgery
10 years ago. (PA wrote “CVA” in PMH. After leaving the exam room, I asked
her why she thought the Pt had a “CVA”? I said I never heard that a CVA
can be removed by a surgery. And then we decided to enter the exam room to
ask the Pt again. The Pt told us that before the surgery he had his hair
shaved on the right side of his head; and during the surgery, the surgeon
drilled on his head to make an incision. Finally, we can confirm that Pt
must had some kind of trauma which cause a “blood clot” in his head that
would need to be removed by surgery. Though the Pt was sent for
cardiovascular clearance, he finally had colonoscopy done without any other
treatment.)

Take home message:
- Never presume the Pt, be an objective and neutral interviewer.
- Never presume anyone, including your colleague.
- Any question, go ahead to ask and communicate.
- Again, Communication is the Key.
IM: Interviews - My First Presentation
- Ms. M., 39 yo F c/o rectal pain for 2 months.
- HPI:
  Worsening rectal pain, intermittent with each episode lasting hours to
days. Throbbing, moderate to severe, at times rated 8/10.
  Denies adequate relief with OTC or previously prescribed treatment. No
clear modifying factors.
  Associated with rectal abscess, ruptured x 2 times, yellow discharge from
the skin surrounding anus. No relief with sitz baths or other treatment.
  Mild rectal bleeding, on and off bloating and diarrhea; no nausea,
vomiting, constipation, or bowel incontinence.
  No fever, weight change or fatigue.

- ROS: Patient is in acute distress
- Allergies: NKDA
- Medication: Advil 
- PMH: Anal fissure after delivery of her child 10 years ago. Small Bowel
obstruction for 2 times (10 yrs ago and 1 yr ago), treated by surgery for
the first time, and by conservative treatment for the second time.
- PSH: Hemorrhoidectomy and sphincterotomy 10 years ago. Small Bowel
obstruction surgery (Pt cannot remember the name).
- FH: None
- SH: Occupation is Make-up artist. No smoke, alcohol or recreational drugs.
- Impression was Anorectal abscess. Need referral to a surgeon. (for
incision and drainage). (Time is too late for those private practicing
surgeon to accept patient, so PA searched in google for GI physician and
surgeon, the #1 is Dr. TongJing. I tried to contact Dr. Jing, but he is not
in the clinic at that time. Patient had to go to the hospital Emergency room
.)

Take-home message:
- SBO are initially managed conservatively, nasogastric tube decompresses
and Contrast enema, IV hydration. Surgery is the last resort which also
increase the risk for complication.
- EGD should be avoided because the air inflated during the procedure will
easily irritate the small bowel to trigger the obstruction.
- This Pt is a rich artist whose sister is a physician and mother is a nurse
, but she ends up being referred by 2 physicians without any treatment and
suffering great PAIN.
IM: EGD/Colonoscopy
Observed Procedures
- Recognize anatomical position under ColonoScopy: the darker and blueness
on the wall of lumen represent Liver flexure and spleen flexure. “Like a
bruise on the colon's face.”
- Terminal ileum: Yersinia enterocolitica, Tuberculosis and Crohn's disease.
- Understand the purpose of EGD/Colon: screening; diagnosis; surveillance.
- Observe biopsy and snare polyps

Entering Procedure Notes
- How to describe the observation under scopy
* EGD: Gastroparesis: food retention in body. DM caused the blood vessels
blocked, and also the nerves that are supplied by those vessels. So the
stomach become denervation and paresis. Gastroparesis Diet given to Pt.
- How to follow-up the special patients:
* a Patient with Cirrhosis surveillance for hepatocellular carcinoma
* a Patient with Prostate cancer s/p radiation therapy---prostatitis+
arteriovenous malformations, sigmoidoscopy to monitor.
* a Patient with Cirrhosis surveillance for Varices (By slowing the heart
rate and widening the blood vessels, non-selective beta-blocker medicines
such as propranolol can be used as conservative treatment.
IM: Call Cases
How to recognize and pronounce those Spanish name? It is hard for me, but I
do learn some simple Spanish pronunciation rules. And I got that most
Spanish people have 2 last names (Which makes their names even longer), but
when you address them you should go to the Middle one not the last one. (At
the same time, my supervisor and colleagues have difficulty calling my names
, and they all call me Leila (a Hebrew and Arabic girl's name), even the
Uber taxi driver did so. At least we both have the same problem)

Talked to hundreds of People with all kinds of ACCENT. Accent is not a
problem as long as you can communicate smoothly. Let's say, a foreigner
studies Chinese very hard and finally can communicate with Chinese people
smoothly, but once he comes to Beijing he sounds still a foreigner. However,
when you study English very hard, and you come to New York, you are a New
Yorker.

Some pt will be nice and appreciate ur call while some will hang up. Don't
take it personally, try to learn and find out a better way to show your care.

As my callings become more and more, I started to come across Chinese
speaking Pts. Our Clinic started to accept walk-in patients who speak
Chinese. (both Mandarin and Cantonese) . They even make advertisement for it.

My best record was 28 appointments made over 2 days.

I failed my phone call case in my CS mock exam. It meant that I need to
improve my English listening especially when I can see neither face
expression nor body languages through the phone.
IM: Course in Dr Korshidi's Clinic
Hepatitis B
- s antigen: Disease
- s antibody: Immunity
- c antibody: anti-HBc IgG for Exposure; anti-HBc IgM for windows period.
- e antigen and antibody: Guide Treatment.
- HBV viral load: DNA PCR: Guide Treatment.

Clinical interview skill
- Do not say “I am sorry to hear that” all the time, but instead, show
empathy to the patient by say “I understand it's difficult for you” or “I
can imagine that you must have been through a lot.”
- When looking at pt's vital, respiratory rate should always less than 16 to
be “normal”, should ask patient whether s/he feels shortness of breath.
Pathology-Slides Reading
- EGD biopsy (antrum, duodenum, cardia, fundus, body, esophagus, ulcer)
- Colonoscopy biopsy (sigmoid, descending, transverse, ascending, terminal
ileum)
- Endometrium
- Breast
- Prostate
- Skin
- Ascetic fluid centrifugation
Helicobacter Pylori Gastritis

H. Pylori gastritis is an infection of H. Pylori in stomach which may cause
chronic gastritis.

- Most patients never experience any symptoms or complications; while others
may appear as acute gastritis with abdominal pain, nausea or dyspepsia.
- Chronic inflammatory infiltrate with lymphocytes, plasma cells and
occasional neutrophils (large amount indicates acute infection) in lamina
propria.
- Special staining of H pylori (Silver or Giemsa) can demonstrate the curved
, spirochete-like bacteria in superficial mucus layer.
- Assco w/Duodenal and gastric ulcer, gastric cancer and low-grade B cell
mucosa-associated lymphoma.
Reactive Gastritis

Reactive gastropathy, also chemical gastropathy, is an abnormality in the
stomach caused by chemicals, e.g. bile, alcohol.

- Foveolar hyperplasia with gland tortuosity and dilation
- Lamina propria smooth muscle hyperplasia: muscle fibers may be seen in the
lamina propria 
- Scant or minimal neutrophilic and lymphocytic inflammation
Barrett Esophagus

Barret esophagus is a complication of GERD.

GERD is caused by transient relaxation of lower esophageal sphimcter and
reflux of acid and bile into the distal esophagus. High risk factors
including: smoking, EtOH, Caffeine, fatty foods, chocolate, pregnancy,
obesity and hiatal hernia.

- Gastric type of columnar cells and Goblet cells (Intestinal metaplasia) in
distal esophagus
- Glandular dysplasia with increased risk for distal adenocarcinoma.
*Vincenza Conteduca,et al. Barrett's esophagus and esophageal cancer: An
overview.International Journal of Oncology.1481:414-424.2012
Melanosis Coli

Melanosis coli is a benign pigmentation of the wall of the colon, identified
during colonoscopy. The brown pigment is Lipofuscin in macrophages, not
melanin.

Most common cause of melanosis coli is the overuse of laxatives. The
anthranoid laxatives pass through the GI tract unabsorbed until they reach
the colon, where they are change into their active forms. These active
compounds cause damage to the cells in the lining of the intestine and leads
to apoptosis (a form of cell death). The dead cells were eaten by
Macrophages and appear as darkly pigmented bodies.
The condition can develop after a few months of laxatives use.
Hyperplastic Polyps

Hyperplastic Polyps is a benign polypoid lesion in the colon, which arises
from the colon and protrudes into the lumen.

Microscopy:
- Cross-sections of glands have a star-shaped lumen.
- Mixture of goblet cells (with abundant mucin) and absorptive cells
- Nuclei are small, regular, round and basal in luminal half of crypt
Tubular Adenoma

A microscopic comparison of normal colonic mucosa on the left and that of an
adenomatous polyp (tubular adenoma) on the right is seen here.

The neoplastic glands are more irregular with darker (hyperchromatic) and
more crowded nuclei. This neoplasm is benign and well-differentiated, as it
still closely resembles the normal colonic structure.
Endometrial Cancer


Clear-cell carcinoma is a type II endometrial tumor (estrogen independent),
arising from atrophic endometrium.

- Highly malignant tumors with aggressive behavior and poorer prognosis.
- Large, clear cells with bizarre and enlarged nucleoli seen.
- Signet ring cell seen with large amount of mucin, which pushes the nucleus
to the cell periphery.
Breast Cancer


Invasive carcinoma of no special type (NST), also known as invasive ductal
carcinoma is a group of breast cancers that do not have the "specific
differentiating features",  a diagnosis of exclusion.

- Sheets, nests, cords or individual tumor cells, are more pleomorphic.
- Ductal carcinoma in situ often seen (DCIS) (up to 80%).
- Calcification in 60% of cases, variable necrosis
Prostate Cancer


Prostate cancer
- Malignant transformation is accompanied by loss of basal cells, solid
growth, single cells layer
- Glands are “too many, too small, too crowded”
- Large gland pattern also occurs and resembles atrophy
- Nuclear enlargement, hyperchromatic nuclei
Lipoma

Lipoma is a benign tumor composed of adipose tissue (body fat).

- The most common benign form of soft tissue tumor.
- Angiolipomas are painful subcutaneous nodules having all other features of
a typical lipoma: mature adipose tissue, branching capillaries and thick
walled vessels; hyaline / fibrin thrombi are an important diagnostic sign.
- Spindle-cell lipomas are asymptomatic, slow-growing subcutaneous tumors
that have a predilection for the posterior back, neck, and shoulders of
older men.
Nevus

Nevus is a form of benign neoplasm which contains nevus cells (a type of
melanocyte)

- Types of acquired melanocytic nevi are categorized based on the location
of cells:
•    Junctional: epidermis
•    Intradermal: dermis
•    Compound: epidermis and dermis
- Small nests of melanocytes in upper dermis, often around pilosebaceous
units
- Differentiation from melanoma:
•    Asymmetry
•    Border
•    Color
•    Diameter
Epidermal Inclusion Cyst

Epidermoid cyst is a benign cyst usually found on the skin and it is made of
a thin layer of squamous epithelium.

- The majority of epidermal inclusion cysts originate from the infundibular
portion of the hair follicle thus explaining the interchangeable
- Young and middle-aged adults are most often affected
- Cyst containing laminated keratin
- May have disruption of cyst wall, acute inflammation, intense foreign body
giant cell reaction
SCC

Squamous cell carcinoma (SCC) derived from keratinocytes in epidermal layer,
is #2 most common invasive skin cancer, #1 is basal cell carcinoma

- Well differentiated: abundant pink cytoplasm, mild to moderate atypia,
well developed keratinization
- Moderately differentiated: focal keratinization; features between well and
poorly differentiated
- Poorly differentiated: no / minimal keratinization, high nuclear to
cytoplasmic ratio, nuclei are markedly atypical or frankly anaplastic
- Undifferentiated: tumors presumed to be SCC based on prior biopsy at same
site, but no keratinization identified by light microscopy;
immunohistochemistry is usually necessary to exclude melanoma or sarcoma
Grossing - Colon Cancer

Verify the specimen #, type and patient's information.

Measure the three-dimension of the specimen and tumor, distance to resection
margins:
    Size (including thickness),
    Extent around bowel circumference
    Shape (fungating, flat, ulcerating)
    Presence of necrosis or hemorrhage
    Extent through bowel wall, serosal involvement (take the depth
of tumor penetration of serosa)

Record the present of appendix, terminal ileum, cecum and ileocecal value

Other lesions in bowel and appearance of uninvolved mucosa; note presence or
absence of associated polyps. (3 seen, each with size and distance to the
tumor)

Estimate the number of lymph nodes found, and whether they appear to be
involved by tumor, or not. Note size range of nodes.
Interview Skill
Either personal statement and interview need to be personalized.
- Use your own and real experience to tell a short but concrete story
- Be a good actor: To talk to different people in different way
- Profile the program director and chairman, read their writings; Mapping
the hospital and the city/state, try to understand their culture, and find
out the benchmark so that you will be ready to talk about it when you need
to.

Be ready to talk about your hobbies, and make it contributory and consistent
to your profile.
- If reading is your hobbies, memorize a favorite excerpt from your favorite
writers, maybe you can use it when you are answering questions or even
ordering a dessert.
- If movie is your hobbies, prepare a “top 5 best movies” which you can
repeat any classic scene, and clarify the reason why you like it.

Be ready to answer the challenging questions
- Prepare to talk about your weak points. Use “however” always when
transfer to your effort and improvement. Show them you are trainable!
- Do not tell things in a negative way but use positive words. e.g. “accept
a good offer from a company” instead of “quit my job as a resident”.
- Understand the culture gap between Chinese and U.S. clinical environment.
Be a learner during your residency, do not take over the responsibility of
your supervisor. When you have doubt, always ask question firstly instead of
challenging
- Use one sentence to describe yourself: I am a person who always give
considerations to the feelings of people around me, I am a good collaborator.
- Give one example to support your statement: I was elected by my team
members to act for the role of scientific communication officer (which was
still vacant due to resource flow), since I was the "go-to" person whenever
they need new data and I developed all the “Q & A” for them.
Learn from Senior Physicians
Pathologist's assistant taught me how to grossing, practice typing, develop
a good habit to write work notes and verify all the information. They also
showed me the structure and function of a pathology lab. I enjoyed working
with them and felt good if I can be some help in grossing and noting.

Physician's assistant and Medical assistants taught me Spanish and help me a
lot through my work. They told me that they would like to be a PA rather
than a physician, who would have to invest more, enjoy less and pay more tax
. Moreover, the PA and nurse practioner can have their own clinic and refer
Pt to specialty Dr. Get Obamacare illustration cartoon video from an Indian
PA student. She is very nice and brought me a lot of chance to observe the
patient encounter.

Get chance to learn about medical insurance: how to check the eligibility,
what's the general difference between commercial insurance and Medicare/
Medicaid, how to talk to anxious Pt who got panic on receiving statement
from insurance company.
Bonus Learning Opportunities
Visit a physician-group private clinic
On Jan 20th, Dr. He provided me a chance to shadow him in a Jewish physician
-group private clinic in Brooklyn.
It was my first time to visit such a neat and quiet clinic. The visit
totally broke my stereotypes of a clinic which always looked like a busy and
noisy chaos. Everything here seemed to be in order, everyone here seemed
polite and respectful. They even put Jewish scripture in a delicate crystal
tube besides the door of every exam room. It seemed to me not only a
decoration, but also a respect for patient and religion, which makes patient
-doctor relationship a good rapport. No one wore white coat here, you cannot
tell who is a patient or not.
At that time, I wish I could have chance to work in such a place. Moreover,
I wish one day I could visit a private clinic of Chinese physician

Pathology Workshop in Manhattan
Dr. He also brought me to a quite creditable pathology workshop in Manhattan
. A pathologist expert introduced his study about using solid versus whole
tumor size on high-resolution computed tomography for predicting
pathological malignant grade of tumors in lung adenocarcinoma. There were
attending and resident pathologists who shared their results and opinions
freely with each other. 
Thanks to Those Who Helped Me Through the Externship!

Life in New York

I visited Metropolitan Museum of Art and Guggenheim Museum.

My roommate is a girl from Taiwan. She guided me through my tour to the
museum and Time square.

Got chance to meet my high school classmate who invite me for morning tea
and a tour in Central park.
My landlord, a Korean girl, and her family provided me delicious foods in a
snow storm day, and also sweet dumplings in the Lantern Festival.

My colleagues from Columbia and Ecuador invited me for a hot-pot dinner and
all of us enjoyed the dinner very much, hot-pot become their favorite
Chinese foods. They also invited me home to prepare dinner for them, but I
ended up not going because of busy schedule, what a pity.
Enjoy Working with My Team
Met Lisa and her family during the morning tea time. Together with Dr. He,
our team really made me feel like a family member.

Lisa is a very warm, friendly and considerate person who helped me go
through the externship, and cared for me “from head to toe”. She is also
the person who knows the program so well that she can assist and coordinate
every single step.

Lisa told me her story. And as a mother, she could understand me quite well
and encourage me from time to time. It is not easy, but at least we take
that first step.

My classmate OJ is pretty earnest and respectful, we practiced cs exam
together; he also taught me how to perform H. pylori breath test and helped
me to find the cheapest but delicious restaurant.
I Learn A LOT from My Mentor – Dr. He

I have been blessed with the opportunity to learn from Dr. He.  Dr. He has
been devoting himself to mentoring CMGs for more than 10 years and over
hundreds of CMGs had benefited from his guidance and writings.  The reason
that someone can persist in doing this cannot be anything but the passion
and love for medical education.  Dr. He is a great mentor who gets
information before making recommendation instead of telling you what to do
directly.  When I met Dr. He for the first time, he peppered me with
questions about how to answer a phone interview and make statement smartly (
and actually he does like pepper very much).  The questioning had clarified
my thoughts and I was impressed by his honesty, integrity, and passing on
his knowledge and experience to his students without reservation.  However,
he is not gentle but very sharp and taught about what I should learn and
behave as a real doctor in US.  He would also use the driving time to
prepared me with interview skill and point out my points needed to be
improved.  This was also a chance to look more closely at myself,
opportunities and what I want in my career life.  I agree with that “
Mentoring is about becoming more self-aware, taking responsibility for your
life and directing your life in the direction you decide.” and I believe
that is what exactly Dr. He is doing.

It's not only the mentoring but also Dr. He's life experiences have inspired
me a lot.  Life can certainly be challenging, but I could not even imagine
what Dr. He had been through and how powerful should he be to fight against
it.  I will say he is a real Blade, a warrior who always confront the
difficulty and break through it.  I would like model myself on him in the
future.


2/28/2017 美国 纽约



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USMedEdu
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: TLL' NY实习随感:Notes for IM/Path Hands-on Externship
发信站: BBS 未名空间站 (Fri Mar 10 12:57:57 2017, 美东)


发信人: USMedEdu (US_CMGs), 信区: Pre_Reside
标 题: 川普的“禁令可能是今明两年CMG的机会!
发信站: BBS 未名空间站 (Fri Mar 10 12:43:33 2017, 美东)

川普的“穆斯林国家禁令”可能是今明两年CMG的机会!

力刀


特朗普最近发布的“穆斯林禁令”也可能祸及外国医学生。有数千名来自穆斯林国家的
国际医学毕业生成功申请到美国的住院医项目,原本应该在3月17日match录取结果公布
后,7月1日到医院报道,很可能受到特朗普禁令的影响,难以进入美国境内。据美国医
学会的分析报告……

这其实对于在大陆的医学毕业生或美国的中国医(学)生(CMGs)来说,是个千载难逢
的机会,这一下减少了中东、南美、东南亚及非洲国家穆斯林集中或其本身就是穆斯林
来美国竞争住院医生位置。给CMG一下子不少名额机会!

尤其是:今年的面试已经结束,本月中,也就是下周,match day——住院医生录取通
知张榜公布日,而在这之前已经通过面试而且很有可能被接受录取的那些国家FMGs很有
可能在7月1日开始培训的时候来不了了!

所以,许多今年参加面试的CMGs应该长个心眼,发挥你的主观能动性积极联系你的人脉
关系,加强与你面试过的单位、培训主任、有影响的高年资医生联系,加强最后时间段
的见习/实习,以取得顶替那些可能已录取却来不成的不幸者!

尤其在下周张榜公布日,请假回家一旦公布后,自己没用被录取,在第一时间,赶紧与
有空额的单位联系,这时,如同打仗抢占制高点,谁先一分钟占据上风,谁就赢了!许
多可能的机会就是那一个小时的时间内!

这时,要在此之前,做好充分的准备:类型单位和主任名单、电话/传真号码、电子邮
件地址、相应的材料、等等。以及你在脑子里过了多次的可能被问及的问题、你的答复
、等。可相见我当年写过的旧文“Match day你该做什么?”、““没有被录取就没有
希望了吗?”等……

不打无把握之仗、知己知彼 百战不殆!利用好难得的机会。机会,只垂青于那些准备
充分,把握十足的人!

谋事在人 成事在天,但即使百分之一的机会,也要用100%的努力去争取!

有志者、有准备者,事竟成!

老刀祝各位同学成功!


3/10/2017 于美国纽约 刀客聊斋/美国病理会诊中心

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OVERDUEFINES
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发信人: OVERDUEFINES (), 信区: MedicalCareer
标  题: Re: TLL' NY实习随感:Notes for IM/Path Hands-on Externship
发信站: BBS 未名空间站 (Fri Mar 10 15:07:11 2017, 美东)

据说SOAP期间不能联系program,不知道我的理解是不是对。

【 在 USMedEdu (US_CMGs) 的大作中提到: 】
: 发信人: USMedEdu (US_CMGs), 信区: Pre_Reside
: 标 题: 川普的“禁令可能是今明两年CMG的机会!
: 发信站: BBS 未名空间站 (Fri Mar 10 12:43:33 2017, 美东)
: 川普的“穆斯林国家禁令”可能是今明两年CMG的机会!
: 力刀
: 特朗普最近发布的“穆斯林禁令”也可能祸及外国医学生。有数千名来自穆斯林国家的
: 国际医学毕业生成功申请到美国的住院医项目,原本应该在3月17日match录取结果公布
: 后,7月1日到医院报道,很可能受到特朗普禁令的影响,难以进入美国境内。据美国医
: 学会的分析报告……
: 这其实对于在大陆的医学毕业生或美国的中国医(学)生(CMGs)来说,是个千载难逢
: ...................



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USMedEdu
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: Good news: One of my trainees matched!
发信站: BBS 未名空间站 (Mon Mar 13 11:35:34 2017, 美东)

Breaking news:

A CMG sent me e-mail: she was matched! she spend one-month externship with
me last summer, and did excellent rotation in IM/Path, and great interview,
I am sure she is accepted by a State univ Path program.

Great news, and congrats!

In addition, many mainland CMGs were matched too!
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USMedEdu
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: 医网情深:十年里,那些感动过我的同学们(之一)(之二)
发信站: BBS 未名空间站 (Mon Mar 13 11:45:37 2017, 美东)

This is the one who was matched just now!


【 在 USMedEdu (US_CMGs) 的大作中提到: 】
: 发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
: 标 题: HLL: 我的病理实习感受
: 发信站: BBS 未名空间站 (Fri Aug 26 02:27:43 2016, 美东)
: 病理实习感受
: 阅读: 95
: 极为炎热而又忙碌的8月,3位CMGs结束了实习,为他仨高兴,祝福他们在九月开始的申
: 请美国住院医生培训过程中好运和成功!
: 何老师:
: 以下是我的一点笔记。其实像您说的,短短时间,不是要学多少病理,而是要知道怎样
: 做病理人。而我最大的感激是您的雪中送炭,急我所需。
: ...................



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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: Good news: One of my trainees matched!
发信站: BBS 未名空间站 (Mon Mar 13 12:28:06 2017, 美东)

Within first hour, 34 CMG from mainland were matched!
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: Good news: Two of my trainees matched!
发信站: BBS 未名空间站 (Mon Mar 13 12:33:48 2017, 美东)

Breaking news:

two CMG sent me e-mail: matched! they both spend one-month GI/Path
combined externship with me last summer, and did excellent rotation, and
great interviews.

I am sure one is accepted by a State univ Path program, another one not know
yet.

Great news, and congrats!

In addition, many mainland CMGs were matched too!  34 matched within first
hour report based on BUG website.


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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: Good news: Two of my trainees matched!
发信站: BBS 未名空间站 (Tue Mar 14 04:21:56 2017, 美东)

发信人: USMedEdu (US_CMGs), 信区: Pre_Resident_Club
标  题: 医网情深:丰收的喜悦
发信站: BBS 未名空间站 (Tue Mar 14 04:14:52 2017, 美东)

医网情深:丰收的喜悦

3/13 上午11点Match day 结果出来了!

两位去年夏天我带教实习病理/内科的女生告知:matched!其中一位
还是大龄毕业多年的老毕业生宝妈!她肯定是将去一个相当不错的州立
大学病理单位!

为她们高兴和骄傲,也平添一份自豪!一把傲骨还能打出几颗钉来。

每年match day,都会让我激动和兴奋,10年里,听到、收到一个个被
美国住院医生培训录取的喜讯,而且,常常有亲自打过来电话告知我喜讯
的。有的激动地泣不成声的,尤其那些毕业15~20年以上、申请失败多次
的同学们,宝妈宝爸们!不容易!连我的秘书助手在看到公布结果后都不禁
感慨地发微信说:今天,我咋都闹的这么激动呢!

这条路进门非常不易,尤其对于毕业10年以上的。我自己是过来人,深深
地知道进门这一脚的难度。我希望把自己的经验教训传给后来人,让更多
的同胞能进入美国临床,扩大我们华裔医生的队伍和提高我们的职业影响!
也好为更多的华裔、亚裔移民服务!

我最感动的是我带教的第一个弟子——他在还没有完成考试和拿到ECFMG
证书、不够申请资格的情况下,破格被霍普金斯大学提前录取!而且,同时
另一所Top 10 大学也给出提前录取的邀请!他说:“不少人做辅导住院医这事,
而只有何老师把这事当做一个事业来做了……”。我感谢他对我的理解!

我年轻时,也曾雄心万丈牛逼哄哄野心勃勃,过了知天命之年,明白自己的
斤两和能力了,我做不成什么大事,就老老实实做一个小学老师,象我的母亲
那样一个普普通通的小学老师,做点启蒙ABC的小事吧!

古人云:莫以善小而不为……


3/13/2017 于美国纽约 刀客聊斋



--
※ 修改:·USMedEdu 於 Mar 14 04:20:31 2017 修改本文·[FROM: 72.]
※ 修改:·USMedEdu 於 Mar 14 04:26:07 2017 修改本文·[FROM: 72.]
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: 今天送走第16位大龄CMG/也聊几句滑膜肉瘤
发信站: BBS 未名空间站 (Thu Mar 16 00:22:22 2017, 美东)


医网情深:老刀会的两位二宝妈——十年里那些让我难忘的同学们(之8)

力刀


去年三月初,我在纽约长岛举办了收费的第三届“老刀会”,可能一是收费、二是如果
参会并接受一对一个体辅导的另加费用“不薄”吧、三是原来未明网站医学职业论坛的
副版主,一个无名小辈见我办班的公告于是阴阳怪气地提醒网友们别被骗上当,最后来
报名参加老刀会的一共五个CMGs,而且只有两个愿意接受一对一辅导,其他三个就旁听
不交费用了。

如此人老茶凉门可罗雀与08、09年我在自己家办的两届老刀会有来自美国加拿大150-
200百人的热闹景象形成鲜明对比,我曾冒出过“办”还是“不办”的私字一闪念。最
后还是大“我”战胜了小“我”:办!就是来一个,我也办!于是,我与我大学77级同
学、纽约健康职业学院的宋教务长联系借用她们学校教室,得到她鼎力支持,又打电话
请来两个病理医生学弟,和一个家在新泽西州热心公益活动、文采飞扬并积极支持我的
内科美女王医生,助手Lisa则事无巨细安排张罗杂务。一个只有五个学员的“第三届老
刀会”如期举行:与会的共三位女同学,两位男同学。两位女同学还是两宝妈,其中一
位乘“红眼”夜班飞机从加州飞来纽约,我亲自去机场接上了她,就直奔长岛的会场。

虽然,场面不热闹,说是“会”,其实只能说是小组讨论而已。但几位医生认认真真,
倾囊相助,详详细细事无巨细地各自介绍了自己的经历和经验,尤其王医生讲述的动人
故事甚至让我感动眼热。上午讲座讨论,中午免费匹萨快餐。吃着还在谈着。紧接着与
两位女同学一对一辅导,从简历、到如何申请、如何面试、从握手、坐姿、眼神到言谈
语速语调、到刁钻古怪问题应答,几位医生给予了充分的指导。王医生下午还有事稍微
提前离开,要知道,她从新州到长岛单程不堵车就要两个小时!我要给她微薄的辛劳费
,她坚决不要:“留着,下次办班用!并表示:老刀,你什么时候要办班,只要与工作
时间不冲突,我一定来,坚决支持你!”我感动不已,与她拥抱告别。

讨论中,两位宝妈认认真真模拟实战面试,我和几位医生一副考官模样横挑鼻子竖挑眼
、找茬儿、挑刺儿、然后解答。她们认真听仔细记,一丝不苟。加州来的宝妈,虽然一
夜“红眼”,依然精神抖擞……下午快五点了,“老刀会”结束,大家握手告别……。

这之后,她们仍与我保持着联系。

一年后,终于,2017的Match day到了!

那位科研成就很好、只申请病理的宝妈,我一直认为她会成功的,虽然只有两个面试,
却得到一个PD节前节后的电子邮件问候——抛橄榄枝啊!终于在11点来信:被录取了!

又收到从加州“红眼”飞来与会的二宝妈短信:就一个面试,被提前录取!而且,就在
纽约!

收到她们的来信,我如同往年,心跳加快,血压升高,眼角湿热——我深知对于她们这
样的二宝妈,一个分数不高而且毕业已10多年、另一个来美后一直在家养两娃,没有工
作经验和人脉,连远门都没有单独出过的,能在仅有的一两个机会里抓住机会成功胜出
,这是多么不易,而又是多么值得敬佩和贺喜的啊!巾帼宝妈不让须眉男爷们!

老刀也一如既往,对于所有勇于走这条路的宝妈们深怀敬意并向你们致敬!相信你们一
定会成功!


3/15/2017 于 美国 纽约 刀客聊斋


【 在 USMedEdu (US_CMGs) 的大作中提到: 】
: Two mainland CMGs rewarded fellowships for USCE externship!
: Both from mainland, one young male surgeon, and one female MS-8 student
with
:  super medical research achievements in a decent US medical center during
: two
: year exchange scholarship and published 3 papers with ranking 5,3, and 2
IF,
:  and one
:  will be orally presented at next month US national meeting.
: Cheers! mainland young CMG kids!
: Bravo!



--
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: 医网情深:老刀会的两位二宝妈——十年里那些让我难忘的同学们
发信站: BBS 未名空间站 (Fri Mar 17 14:54:00 2017, 美东)


2016的战果:两位CMGs进入纽约内科、一位进入州立大学病理!全部都是巾帼女将,其
中两位宝妈,两位来自加州!祝贺她们的辛勤努力和艰苦奋斗,今天得到了回报!


【 在 USMedEdu (US_CMGs) 的大作中提到: 】
: 今天送走第16个我亲自带教辅导的中国老医学毕业生(CMG)。回家整理文件,无意中
: 翻到三月份住院医生录取张榜公布那天,一位国内毕业生,虽无直接接触,数次通过电
: 子邮件和电话交流的,来信报喜:他被录取了!做为老毕业生进入和完成美国住院医生
: /Fellowships培训,一路走来深知不易、艰辛和处处暗藏的危险、所以,打定主意亲自
: 辅导实习带出了13个毕业15-23年的老CMG其中4个进入内科、9个病理住院医生。除了三
: 个正在住院和fellowship培训,其他已毕业称为医生开始了他/她们的新生活和职业!
: 但革命尚未成功,吾当继续努力,争取看到更多的CMG包括毕业多年的也都进入美国住
: 院医生培训,壮大我们华人医生的队伍!打油涂鸦一阙自勉:
: 天命之年意若何?济世悬壶坎坷多。
: 愿把一身傲筋骨,淬火锻得钉几颗!
: ...................


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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: 2016战果:内科2、州立大学病理1,3位女同学两位是宝妈!
发信站: BBS 未名空间站 (Sat Mar 18 23:06:31 2017, 美东)


刚收到的一个国内CMG发来的短信:

何老师,我match上XXX hospital/university of XXX 的 prelim surgery, 路还长,
感谢您当时从美国打电话给我点拨,谢谢。

我的回信:祝贺!需要进入前加紧热身,进入后除繁忙的工作,立即着手申请下一年的
去向了!

XXX:是的,还是想做外科 感谢您的指点。到时侯再向您update[抱拳]

后生可畏,长江后浪推前浪!今后,国内学子将会成为进入美国住院医培训的主力阵容
了!


3/17/2017

【 在 USMedEdu (US_CMGs) 的大作中提到: 】
: 今天送走第16个我亲自带教辅导的中国老医学毕业生(CMG)。回家整理文件,无意中
: 翻到三月份住院医生录取张榜公布那天,一位国内毕业生,虽无直接接触,数次通过电
: 子邮件和电话交流的,来信报喜:他被录取了!做为老毕业生进入和完成美国住院医生
: /Fellowships培训,一路走来深知不易、艰辛和处处暗藏的危险、所以,打定主意亲自
: 辅导实习带出了13个毕业15-23年的老CMG其中4个进入内科、9个病理住院医生。除了三
: 个正在住院和fellowship培训,其他已毕业称为医生开始了他/她们的新生活和职业!
: 但革命尚未成功,吾当继续努力,争取看到更多的CMG包括毕业多年的也都进入美国住
: 院医生培训,壮大我们华人医生的队伍!打油涂鸦一阙自勉:
: 天命之年意若何?济世悬壶坎坷多。
: 愿把一身傲筋骨,淬火锻得钉几颗!
: ...................


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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: Good news: One of my trainees matched!
发信站: BBS 未名空间站 (Sun Mar 19 13:01:23 2017, 美东)

刚刚收到两位女同学的报喜:

一个Emory、一个UW、都是病理!
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: 2016战果:刚收到2位女同学报喜:Emory,UW--病理!
发信站: BBS 未名空间站 (Sun Mar 19 16:17:38 2017, 美东)

t今年,我现在收到的喜讯:3个女同学进入美国很好的病理住院:Emory、宾州州立大
学、UW!纽约一个内科、佛州一个外科preliminary!真替她/他们高兴!
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: Good news: One of my trainees matched!
发信站: BBS 未名空间站 (Thu Mar 23 00:59:17 2017, 美东)

住院医申请的一点回顾

阅读: 577  & 分享: 21

- HL


考试分越高越好,毕业年限越少越好,实习越多越好,人脉越广越好,自己呢?每个人
的情况都是独一无二的,面对的问题也是各种各样的,我只想写下对我重要的几个阶段
,算是一个纪念。

1. 理想与现实

我要做医生,很小就有这个愿望。虽然时隔15年,当决定考U申请时,我脑子里唯一的
念头就是内科。去年,也是三月,纽约,第一次见到老刀和几位在美行医的前辈。当我
说完我的背景和愿望的时候,老刀和几位前辈几乎一口同时的对我说,你应该选病理!
我的脑袋嗡的一下,忍住泪水,以一个科研工作者的严谨逻辑,顽强反击。就像绝症病
人听到诊断后的反应阶段一样,接下来的几个月,经历了否认,绝望,接受的过程。于
是,我还要做医生,只不过我的理想接受了现实,我要做病理医生!

2. 机遇无价

六月底考完CS,七月开始联系见习,我虽然在很大的医学院工作,却碰壁无数,美丽的
机会如缕缕青烟,始终有缘无分。看着自己还不错的成绩,我竟有一种英雄末路的苍凉
。七月底求助老刀,要求在八月底完成实习,拿到推荐信。何老师爽快的答应了!我的
申请道路路转峰会,一下子我又进入了快车道。

3. 决不放弃

其实回过头想想,考试是这个过程中最容易的,唯一在自己掌控范围内的。从考试结束
以后,就再也没有可以确定的了。递交材料后就眼巴巴的盯着邮箱,祈祷别人的关注,
而心情就像过山车。收到面试的惊喜,面试后的感慨,与program短暂失联的沮丧,被
告之无望的失落,而大部分的时间就像暗恋中的人儿,不停揣测期望而又没有丝毫音讯
。在虐心的等待中,我完成了step3,不放弃任何可以骚扰PD机会,逢年过节,更新信
息,虽然大部分的邮件都石沉大海,但只要没明确说不要我,我就继续!

短暂的几个月,却仿佛好久好久。申请过程掺杂了个人努力,机遇,运气等诸多无法预
测的因素,无法衡量孰轻孰重。但此刻愿忘却所有苦难,只记得满心的感激,感谢亲爱
的家人在过去,现在和未来的无私支持,感谢一路上认识的志同道合的朋友和老师,互
相分忧解难。成功,因为有你们!谢谢!

HL
3/23/2017
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USMedEdu
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: HL:  住院医申请的一点回顾
发信站: BBS 未名空间站 (Wed Mar 29 15:34:48 2017, 美东)


从USMLE到Matched——这一路走来的感受

SJ

2017年3月 17日,这应该是这三年多来,我最害怕却又最期盼的日子,所有的努力和付
出,汗水和泪水,都将在这天有个结果。还好,最终,我的结果是好的,我很满足。
 
回顾这一路,很多感受,经验和教训,在这里小忆一下,供后来人参考,也算是还了自
己的一个心愿。
 
从开始准备USMLE的那天开始,前辈们就告诉我要考高分,step1,step2 CK,能多高就
多高,不设上限。因为你无法改变你毕业超过十年的事实,也暂时申请不到绿卡。那你
能提高的硬件,就只有这点了。但我想这点其实也基于个人情况,如果你的时间充足,
没有经济问题,没有家庭矛盾,自然是可以往高分冲。若不是,那就酌情考虑。
 
这条路不易,自己单枪匹马走下来,更不易。所以找到志同道合的考友,显得尤为重要
。他/她们必将成为你今后的挚友,同事,甚至老师。所以,不要放弃任何交朋友的机
会,这就是所谓的人脉,所谓的Connection.
 
一步一步考完,自然就是找实习,见习。找到这样的位子并不容易,如果你有人脉,有
connection,能去到社区医院,大学医院,或者诊所里免费学习,自然是最好不过的。
但如果你没有,经济条件允许的话,商业见习也是不错的选择。例如,我自己就曾经得
益于老刀前辈的帮助,经历了一个月的内科/病理,了解了美国医疗的体系,并拿到了
很好的推荐信。
 
接下来的面试季,你要做好充足的准备,因为有很多材料,需要你亲力亲为,反复修改
。申请项目,要你一一核实,不符合条件的基本就可以不申请了,当然如果你是富二代
的话除外。我自己申请了200多个项目,大把的银子,就这么走了。但还是觉得是值得
的,作为CMG,我们只能广撒网,没拿到面试前,谁心里都没底。
 
幸运的,我拿到了面试。在这个季节,会有各式各样的免费面试讲座,也有付费的。根
据自己的情况,来选择。很多讲座都是很值得借鉴的,会讲很多细节,要时刻注意收集
个种信息,尤其是MITBBS, Wechat group里都有很多选择。准备好了,面试来了,那就
开始面吧。打一场有准备的仗。
 
如果仗打完了,那就不要再想东想西了,安下心来,复习step 3。这段时间,我的心情
总是沉淀不下来,不想学习,陪着女儿到处玩儿。其实想来是浪费了一些时间。如果好
好利用,在program rank之前就考完step 3,跟PD update一下,或许会更好。
 
还好,还好,我的match day 结果是好的,是我满意的。这一路走来,经历了很多,也
收获了很多,要感谢的人更是数也数不清。在这里,就统说一句,感恩,感谢!
 
小忆一下,只希望对后人能有帮助。
 

03/18/2017



【 在 USMedEdu (US_CMGs) 的大作中提到: 】
: 今天送走第16个我亲自带教辅导的中国老医学毕业生(CMG)。回家整理文件,无意中
: 翻到三月份住院医生录取张榜公布那天,一位国内毕业生,虽无直接接触,数次通过电
: 子邮件和电话交流的,来信报喜:他被录取了!做为老毕业生进入和完成美国住院医生
: /Fellowships培训,一路走来深知不易、艰辛和处处暗藏的危险、所以,打定主意亲自
: 辅导实习带出了13个毕业15-23年的老CMG其中4个进入内科、9个病理住院医生。除了三
: 个正在住院和fellowship培训,其他已毕业称为医生开始了他/她们的新生活和职业!
: 但革命尚未成功,吾当继续努力,争取看到更多的CMG包括毕业多年的也都进入美国住
: 院医生培训,壮大我们华人医生的队伍!打油涂鸦一阙自勉:
: 天命之年意若何?济世悬壶坎坷多。
: 愿把一身傲筋骨,淬火锻得钉几颗!
: ...................


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USMedEdu
进入未名形象秀
我的博客
[回复] [回信给作者] [本篇全文] [本讨论区] [修改] [删除] [转寄] [转贴] [收藏] [举报] [ 31 ]

发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: SJ: 从USMLE到Matched——这一路走来的感受
发信站: BBS 未名空间站 (Wed Apr 12 14:47:14 2017, 美东)

发信人: USMedEdu (US_CMGs), 信区: Pre_Resident_Club
标  题: 第四届美国住院医申请学员结业面试辅导暨老刀会(2017年4月
发信站: BBS 未名空间站 (Wed Apr 12 14:41:56 2017, 美东)

第四届美国住院医申请学员结业面试辅导暨老刀会(2017年4月)
时间:2017年4月30日,星期日
地点:纽约州长岛市
举办方:
IAMC* & ADCS **
Department of International Education, NY College of Health Profession

* IAMC: International Association of Medical Consulting Inc.
**ADCS: American Diagnostic Consultation & Services, LLC

日程安排:

- 纽约4月份学员心得讨论

- 纽约4月份学员的结业面试(医生团队)及点评分析

- 其他报名学员的模拟面试(医生团队)及点评分析

我们会对每个模拟面试进行录像,之后会把录像提供给相关学员供之后自我分析。

如果有对申请住院医感兴趣并希望参加旁听或者参加模拟面试的,可以报名参加(us.
[email protected])。
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FROM: 2607:fb90:2492:]
【 在 USMedEdu (US_CMGs) 的大作中提到: 】
: 今天送走第16个我亲自带教辅导的中国老医学毕业生(CMG)。回家整理文件,无意中
: 翻到三月份住院医生录取张榜公布那天,一位国内毕业生,虽无直接接触,数次通过电
: 子邮件和电话交流的,来信报喜:他被录取了!做为老毕业生进入和完成美国住院医生
: /Fellowships培训,一路走来深知不易、艰辛和处处暗藏的危险、所以,打定主意亲自
: 辅导实习带出了13个毕业15-23年的老CMG其中4个进入内科、9个病理住院医生。除了三
: 个正在住院和fellowship培训,其他已毕业称为医生开始了他/她们的新生活和职业!
: 但革命尚未成功,吾当继续努力,争取看到更多的CMG包括毕业多年的也都进入美国住
: 院医生培训,壮大我们华人医生的队伍!打油涂鸦一阙自勉:
: 天命之年意若何?济世悬壶坎坷多。
: 愿把一身傲筋骨,淬火锻得钉几颗!
: ...................


--
※ 来源:·WWW 未名空间站 网址:mitbbs.com 移动:在应用商店搜索未名空间·[FROM: 2607:fb90:2492:]

 
USMedEdu
进入未名形象秀
我的博客
[回复] [回信给作者] [本篇全文] [本讨论区] [修改] [删除] [转寄] [转贴] [收藏] [举报] [ 32 ]

发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: 第四届美国住院医申请学员结业面试辅导暨老刀会(2017年4月
发信站: BBS 未名空间站 (Fri Apr 14 00:30:59 2017, 美东)


带教、实习、普普通通快快乐乐的美国医生工作和生活

一大早带着三个实习生到办公室,还带了一盆鲜花给我们的小护士妹妹,
祝贺她被杜克大学护士学院录取。她刚从手术室出来,看到我俩的工作
台上的花,高兴地给我一个大hug,正亲热呢,看到大秘书端来一个蛋糕,
我还糊里糊涂地问谁过生日啦?,突然大家围过来对着我唱了起来,我才
反应过来……好感动好温馨的大家庭哦!

吃饱喝足了,干活儿了。三个实习医生很用功勤奋努力,不到两周,内科
实习生跟两个胃肠科医生轮转感觉很爽、两个病理实习生在实验室、医院
和办公室学习了标本处理,切片染色、开始熟悉我用的四种软件并在监护
下学着签发报告,昨天帮着我两个小时干掉两座大山。

虽然十分忙碌劳累但快乐着:这就是普普通通的美国医生的工作和生活……




【 在 USMedEdu (US_CMGs) 的大作中提到: 】
: 今天送走第16个我亲自带教辅导的中国老医学毕业生(CMG)。回家整理文件,无意中
: 翻到三月份住院医生录取张榜公布那天,一位国内毕业生,虽无直接接触,数次通过电
: 子邮件和电话交流的,来信报喜:他被录取了!做为老毕业生进入和完成美国住院医生
: /Fellowships培训,一路走来深知不易、艰辛和处处暗藏的危险、所以,打定主意亲自
: 辅导实习带出了13个毕业15-23年的老CMG其中4个进入内科、9个病理住院医生。除了三
: 个正在住院和fellowship培训,其他已毕业称为医生开始了他/她们的新生活和职业!
: 但革命尚未成功,吾当继续努力,争取看到更多的CMG包括毕业多年的也都进入美国住
: 院医生培训,壮大我们华人医生的队伍!打油涂鸦一阙自勉:
: 天命之年意若何?济世悬壶坎坷多。
: 愿把一身傲筋骨,淬火锻得钉几颗!
: ...................



--
※ 来源:·WWW 未名空间站 网址:mitbbs.com 移动:在应用商店搜索未名空间·[FROM: 72.]


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