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医网情深:我的2018病理住院医生面试体会分享 /Alice
[版面:医学职业][首篇作者:USMedEdu] , 2016年04月29日23:45:18 ,16617次阅读,134次回复
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USMedEdu
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: 医网情深:我的2018病理住院医生面试体会分享 /Alice
发信站: BBS 未名空间站 (Fri Apr 29 23:45:18 2016, 美东)

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!

4/29/2016 美国纽约 刀客聊斋/美中医学教育网

































































































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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
发信站: BBS 未名空间站 (Mon May  2 15:07:21 2016, 美东)

也聊几句滑膜肉瘤:

魏同学的病逝让我的专业科目里一个少见肿瘤:滑膜肉瘤立刻火爆
被人们熟知其名了。这里,就老刀在中国妇产科医生网群里的随笔,
简要介绍一下吧:

滑膜肉瘤其实不是滑膜组织发生的!可以在任何器官组织发生!我是
病理医生,在华盛顿大学进修外科病理、芝加哥大学进修软组织骨肉
瘤病理,见过许多这个肿瘤、发生在除关节软组织外,妇产科、男性
生殖泌尿、喉头、肺纵隔,等部位,除了脑、心脏、眼球、我没有见
过。

滑膜肉瘤是一个少见的,中度恶性肉瘤,多发生于中青年,也见于儿
童和老年人。病理诊断有四种类型:多见的是单纯梭状细胞型和腺体
梭状细胞混合型、后者多见一些、容易与其他肉瘤或腺癌混淆误诊。
男女之比1.2:1;好在它有比较特殊和特有的基因突变:t(X,18).所以
诊断时若考虑到这个肿瘤的鉴别,采用相应组化染色和分子诊断,多
可确诊和区别与其他的腺肉瘤……

治疗仍以手术(1-2期)、化疗,放疗和最近的细胞免疫治疗…。
肿瘤5厘米以下,没有明显肉眼和镜下坏死,核分裂10/高倍视野以下,
手术加化疗局部放疗效果不错,80%~可以存活5年以上。新一代PD1/PDL1
免疫治疗有报告但病例数少,尚未最终确定,但是对于晚期患者是增加
一种治疗的可能有效方法……。

PD1/PDL1尤其对于3、4期无法手术、和远处转移复发病例,是一种新的
治疗方法、现在也有大药厂在研发基因治疗药物和第二代PD1/PDL1,希
望2-3年后有新进展!总之,在妇产科,见到肉瘤、要想到这个肿瘤的
鉴别诊断!
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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 May  5 14:07:08 2016, 美东)

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: Two CMGs rewarded fellowships for USCE externship!
发信站: BBS 未名空间站 (Thu May 19 15:05:52 2016, 美东)

One more female CMG applying for Pathology is awarded for fellowship in this
July for USCE!

Cheers!

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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: Two CMGs rewarded fellowships for USCE externship!
发信站: BBS 未名空间站 (Mon Aug  1 00:25:50 2016, 美东)


何老师,
您好,我的见习感想已写好如下。谢谢您的无私分享和帮助指导。再次感谢!


见习感想

来到纽约已满一月,收获颇多,各种认识和观念也发生了很大变化。

首先,美国的医疗体系和中国还是有很大差别的。私人诊所就是最主要的差别之一。
PCP和专科医生自己在美开诊所还是比较常见的。我所在的胃肠专科医生,从之前在
大学医院里工作,到自己开诊营业,在胃肠领域已经有十几年经验。从申请诊所的运
营资格,卫生部门各种定期审核,到前台咨询,电子病例系统,再到和麻醉医生,家
庭医生,病理医生,以及医院,药房的各种交流沟通,最后到跟各家保险公司的
billing,
都需要医生亲力亲为,统筹全局。现在想来,实属不易。

其次是医生和病人关系,让我也有很大改观。医生会给病人足够的时间去尽量讲述病人
自己的病情,微笑,倾听,耐心都很重要。

最后是系统的了解了病理行业的执业方向,医院,公司,TC/PC,physician group, 等
都是可行的。

病理是一个承上启下的学科,病理医生也起到桥梁作用。通过参观病理诊断公司的Lab
运作,全面了解了病理切片的整个制作过程。对今后理解病理读片,是有非常大的帮助。
虽然只有短短一月,但已经对我的医学思维产生了不小的影响。

相信,这段见习经历,对我今后的医学生涯会是很有帮助的。非常感谢何医生,J医生,
T医生,Y医生的无私分享和指导。前辈们的经验将会是一笔宝贵的财富,永久的传承下
去。

祝好。

JSS



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USMedEdu
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: JSS: 见习感想
发信站: BBS 未名空间站 (Sun Aug  7 01:59:23 2016, 美东)

没见过这样无耻的版主!
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: JSS: 见习感想
发信站: BBS 未名空间站 (Wed Jan  4 13:39:38 2017, 美东)

医网情深:十年里,那些感动过我的同学们(之一)

力刀


自2006年3月无意中进入北美未明空间网站的医学职业版,并开始义务辅导中国
医(学)生(CMG)申请和面试美国住院医生培训的活动以来,10年来,见识
和结识了上百上千CMGs,许多甚至虽未谋面却结下不解之缘和友谊。

他们虽然说是来找我咨询辅导,其实,这是个双向交流的过程,他们以自己的经
历和故事也不断地感动了我、给予我更大的勇气、兴趣、信心和灵感,丰富着我
的教学培训经验,也让我得以坚持十年下来,并乐此不疲……

这10年里辅导过程中,所见识一些同学的经历和故事,感人而且励志,我会选择
陆续简介给立志要成为美国住院医生的国内外CMG们:


1. 没考完资格证书考试却被提前录取的C同学:

C同学是美国一个中流学校博士研究生和博后,没有发表过什么大牌杂志科研文
章。他曾两次参加我在自己家院子里举办的住院医生申请面试培训辅导/“老刀会”,
而且会后总是非常勤快地帮助我和家人打扫卫生,清理完垃圾和院子才又开车一
个多小时赶回家所在的另一个城市。

他跟随我进行了一个半月的病理实习,由开始时候的马马虎虎不够认真,到结束
时的兢兢业业一丝不苟,进步显著。积极参加各种病理住院的平时工作和培训,
并主动打杂活儿打下手为住院医生提供帮助,如大体器官取材、尸体解剖时做记
录、提供取材盒、清理解剖案头和完成的标本残余,节省了住院医生的时间和减
轻其工作负荷。住院医生们都喜欢他,常主动来叫上他参加一些力所能及的工作。

参加系里的学术交流讲座(Grant round),他也能恰如其分在合适的时间、地点
以合适的方式和口吻、提出合适和有水平的问题,让讲座者欣喜不已,也让我的
医生同行和主任刮目相看。系里几位医生都对他赞口不绝,并主动表示可以提供
有力的推荐信。

最令我惊叹和感动的是,他在A还没有考过Step2 CS的情况下,也就是说还没有
得到ECFMG证书、无法通过ERAS/NRMP系统正式启动住院医生申请的情况下,
分别被美国两所排名前十的大学病理系给予择优提前录取(Pre-match)的机会。
而且,这期间另一所很好的州立大学系主任和培训主任二人也曾以电话会议方式
打到我办公桌上,希望进一步证实他们的评估,也是考虑提前录取他,并因此希
望听听我的意见。

最后,他去了全美最好的、以培训极为严格甚至残酷著称的病理单位,完成住
院医生培训后又接着在那里完成专科医生培训(Fellowship)。现在一所大学里
任教和行医,承担着医疗、教学和科研三位一体的职责。他夫人也紧随其后,
完成内科住院医生培训,在他大学附近的一所医院里任职开始行医。全家过上了
幸福快乐的新生活……

(待续)


09/10 美国纽约 刀客聊斋
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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)
发信站: BBS 未名空间站 (Wed Jan  4 14:23:53 2017, 美东)

医网情深:十年里,那些感动过我的同学们(之二)

力刀


自2006年3月无意中进入北美未明空间网站的医学职业版,并开始义务辅导中国医
(学)生(CMG)申请和面试美国住院医生培训的活动以来,10年来,见识和结
识了上百上千的CMGs,许多甚至虽未谋面却结下不解之缘和友谊。

他们虽然说是来找我咨询辅导,其实,这是个双向交流的过程,他们以自己的经历
和故事也不断地感动了我、给予我更大的勇气、兴趣、信心和灵感,丰富着我的教
学培训经验,也让我得以坚持十年下来,并乐此不疲……

这10年里辅导过程中,所见识一些同学的经历和故事,感人而且励志,我会选择陆
续简介给立志要成为美国住院医生的国内外CMG们:


2. 一位坚强的两宝妈医生


这是一位我素未谋面的两个孩子的妈妈、一个大龄医学毕业生。某一年,我开车去某
城市开学术年会,回来的路上我接到一个电话——

“老刀、何医生、你可能记不得我的,我曾经几次给你写信,也电话联系过的。我是…
…、
我现在是一个专科医生,就在你开会的城市工作,真不巧知道你来开会的消息,可你
已经离开了!就想和你聊聊……”

我真想不起来她当初与我来信交流的内容了。但是,听着她急切和柔和的语气,于是
我们开始了断断续续的长谈——丘陵地带,手机信号时而中断,我们一直交谈,更多
地是我听她的诉说,不断地断线再挂上继续交谈,一路长途,几乎两个多小时……

“你知道吗?我这一路走下来,多少次想放弃了,看到你博客的文章、和你通信或电话,
我又满血鼓起劲儿走下去了……这一路,走的好辛苦……”

“没有告诉过你我当时真实的情况,我先生做科研,我有两个孩子,相差几乎10岁。
我的USMLE考试成绩也不错,学位也基本上可以拿到手了,准备申请住院医生似乎
一切挺顺利的。可是,我的丈夫科研基金到期没有能重新续延和申请到新的基金,
做的方向又太专和窄、一下子没有了工作。经济上立刻紧张了……

更不幸的是,我要二宝年龄大的原因吧?他两岁多时发现有严重的健康问题!我们真
是为此心力交瘁。这时,我面临着申请住院和面试阶段的关键时期。我俩反反复复考
虑,计算了生活开销,打算如果成功,用我住院医生的工资能够活下来就行!于是决
定:先生在家照顾孩子,我上!

于是,我开始了申请、面试的艰苦奋战,这期间也得到你老刀的许多鼓励和面试技巧
指导,我比较幸运被当地一个中小医院内科录取了。开始了住院医生的培训。

进入住院才知道,这哪是我能想象到的辛苦、艰难甚至残忍!第一周、第一个月、简
直就是糊里糊涂,整日被骂的提心吊胆,吃不下饭睡不着觉、头发大把大把的掉,人
似乎一下老了10岁,随时随地都可能被踢出去的感觉,抽着一点空,躲在洗手间或图
书馆角落里哭泣,还要捂着嘴、不敢发声。回到家,怕丈夫担忧、更怕影响二宝,更
不敢哭,硬是咬牙吞泪啊!多少次,我都觉得自己到了崩溃的边缘,想退出去不干了!

……,……。

说到这儿,她已是泣不成声……,我在电话那头,也已泪流满面……。

“记得我咨询过你,你狠狠地痛骂了我一通!”……

我哽咽地抱歉:我真不知你是那样的情况,你要是告诉我当时是那样的情况,我绝
不会,甚至……”

“不是的,不是那个意思,何医生、你猜怎么着?你那通斥责和痛骂,没有让我气馁
或对你怀恨,我听着你的吼声,反而感到轻松,反而清醒了,我倒是很高兴你那样严
厉的斥责让我明白,我可以做下去的,没有理由放弃、不坚持下去,为了自己、为了
我的家、我的孩子!“

“我感谢你的真诚和鼓励!让我有了走下去的力量!”

从那以后,我越来越少地自我抱怨和气馁,能挺胸抬头、更多地以微笑面对每天的生
活和工作中的困难、批评责斥,工作开始得心应手,一年级结束时,主任、总住院、
同班同学们对我刮目相看、越来越和睦相处,成为第三年的总住院医生带新生培训,
主任都很放心。

三年内科住院毕业,我和丈夫商量又决定去另一个城市做专科fellow三年呐!和家人
分开,与孩子分开,那滋味真是……(她再次泣不成声……)

我现在都有些昏昏地想不起来了自己是怎么又熬过来这三年的!做完专科培训,回到
这个城市,由于竞争太激烈,只能找到一个较偏远、环境不是太好的地区一个与几位
医生合作的诊所工作。但我也很感激了,感恩有了比住院医生之前好多了新的生活、
可以和我深爱的人、我的孩子们在一起了!

“我努力工作,热情对待自己身边所有的人,用我的知识和技能使得几位高年资医生完
全信任我的医疗水平,所有职员秘书们与我和睦相处,我的病人的赞誉和人数也越来
越多……我成为这个集体的支柱之一……

我的二宝在丈夫和医护的关照下,我的更多的陪伴下,病情大大好转随着发育长大,
明显朝着理想的健康方向发展。大孩子学习成绩优异,上了当地很好的中学进入优异
学生行列。我的收入,不需要丈夫再为科研基金得到与否担忧……

我很高兴我这些年吃的苦有了回报……”

我穿山越岭,在宛转起伏的山路上开着车、静静地听着她娓娓讲述着她的故事,不断
地擦着泪、从心底赞叹:好一个不让须眉的巾帼!一个坚强的宝妈!

她一再感谢我给她的辅导和帮助,其实,她的经历和故事更多地鼓舞和感动了我自己!

我感谢她给我上了一堂生动的人生旅程的课!

……。

(待续)


01/04/2017 于美国纽约
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USMedEdu
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: 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 (Sat Jan  7 19:54:40 2017, 美东)

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。

记随何医生实习

作为毕业15 的老CMG,今年终于走到了住院医申请的一步。不论成败,只为给自己曾
有的一个医生梦一个交代。仓促间七月考完CS,终于瘫坐在沙发上,却发现下一步是那
么的模糊。

目标明确的考试只是泥泞前进的一个开始,见习(observeship,OB)也只是迈出的又
一步。原以为容易找到的OB,原以为优秀的自己,原以为可以通融的关系,我竟然四处
碰壁,一声叹息后,想起了何医生(老刀)。

网上的评价太多太多,百般陈述。然而对于我,何医生是唯一的救命稻草,同意在九月
前接受我实习。怀着满满的感激,我来到了纽约。在病理实验室从Grossing,
embedding,到出片,读片,sign out。点点滴滴,我体会着病理医生的责任与自豪。
何医生很有性格,爱憎分明,对于学生满是关心爱护,毫无保留。畅谈职业,人际中的
各个细节,帮我们进行最细致的准备。几周不可能完成4年病理住院医的皮毛,但却使
我懂得了这个职业的特点和内涵,懂得如何去帮助临床医生和素未谋面的病人,还有了
一个完善的申请计划。

短短的实习即将结束,我学到的不仅仅是病理的基本流程,而且渐渐清晰了成为一个优
秀病理医生的道路,对未来的期待与自信。

何医生,在这病理住院医申请的道路上,感谢您在我最需要的时候伸出了援手,也感谢
您的尊尊教诲,而我,将奋力向前。


HLL
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USMedEdu
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: 医网情深:十年里那些让我难忘的同学(5)
发信站: BBS 未名空间站 (Fri Jan 27 15:41:12 2017, 美东)

医网情深:十年里那些让我难忘的同学(5)

2017-01-27医网情深阅读 87


搬家翻出来珍藏的一对小礼物:我带教实习的第一对申请住院医的中国医学生。

那时我还在OSU工作。他俩非常勤奋好学,与同事、住院医师关系打得火热。冰冻切
片室的带教主任常跑来赞扬他俩,住院医生们也常常主动来找他俩参加尸体解剖、大
外科标本取材。尤其女同学,心细认真,布置的作业完成的非常好,几位老师都喜欢
她。她是从加州飞过来找我带教实习的。家中还有两个孩子,小的才一岁多吧?临结
束实习时,她给我了这个飞鹰的雕塑艺术品礼物。我给她的娃娃买了两个布绒玩具
熊。她接过礼物,眼泪就掉下来了……。

她的认真细致对比的男同学粗糙让我狠狠训斥了一顿。但他很快就改正了缺点,兢兢
业业地完成了实习,最后,在没有CS成绩的情况下被美国头牌单位提前录取。女同学
虽然没有进入她理想的病理专业,但也同年被一个大学内科正式录取。

现在,两人都已毕业有几年了……。看到这小礼物,想念我带的第一对成功的实习生!





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此主题相关图片如下:

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zhzhaa
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发信人: zhzhaa (麦地), 信区: MedicalCareer
标  题: Re: 医网情深:十年里那些让我难忘的同学(5)
发信站: BBS 未名空间站 (Tue Jan 31 15:40:59 2017, 美东)

Thank you
:)
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: 医网情深:十年里那些让我难忘的同学(5)
发信站: BBS 未名空间站 (Sat Feb 18 20:47:56 2017, 美东)

来美纽约病理和内科实习生活点滴(之一)——法拉盛生活资料小结

OJ


去年联系了美国病理会诊中心的何医生(网上出名的老刀)和Lisa,安排来美国纽约进
行为期2~3月的内科和病理实习(Externship)。地点:皇后区,法拉盛。

皇后区法拉盛地图如图所示。
主要街道 Main street ,roosevelt ave。

重要的地理标志物:图书馆(queens library),新世界商场,梅西百货 (macy’s)
红色三角L型紧挨着L的长方形

吃饭:
1. 缅街和罗斯福交接有一个 新世界商场,地下负一层有美食广场(和中国国内商场的
美食广场没有区别,拉面、炒饭、烧烤、糕点、南北方、江浙川粤台等各式风味餐馆排
档;

2. 新世界商场的2个入口对面分别有2个快餐店(图中黑色圆圈,类似于中国国内几菜
一汤,6元左右);

3. 缅街和罗斯福大道上有各类连锁快餐及未标明的各类美食广场(太多了。)

或 自己做饭新世界商场,以及周围,有多家中国超市,可以买到油盐酱醋以及各类蔬
菜、肉类和水果,价格非常便宜;

日常百货:
1. 缅街靠近northern blvd有一家大型的99美分店(质量,品类比较优质)(每条路基本
都有99分店,太多了,不过质量不一);

2. 梅西百货,新世界商场;

3. 罗斯福大道往西走与大学点大道(College Point Ave)交界处(图中标示了红色长
方形)有一家超级天景商场(Skyview Mall),内有中国食品日用品超市,Marshalls'
(卖折扣衣物),优衣库、Target(类似于中国国内的大型超市),各类折扣店,火锅
、赛百味餐厅和咖啡糕点店,理发店、电器店best buy,阿迪达斯专卖店、Nike专卖清
仓减价店、BJ超市、大通银行、等;

强烈推荐此处,因为附近的中国超市基本都是只卖食物、日用品),以及各类连锁店。
离它50米,在罗斯福大道上纽约美食城,里面各地风味小吃都有,干净、快捷、价格合
理。

租房
1. 图书馆(图中红色三角形)后面的香港商场(只有三家店,coco奶茶,手机话费店
,理发店)内,有一公告板内含各类租房信息

合租10-15美元一天(2-5人一屋子,屋内基本都有 冰箱,厨具,淋浴、wifi);单
间600-900美元/一月。

有许多房东在此处等待房客,可直接与其交谈看房

2. 网站 www.dadi360.com ,有”法拉盛租房“分类;

3. 超市 洗衣房 都有布告栏,上有信息;

4. 手机 airbnb,按档次大约25-50美元一天不等。

图书馆

可以从queenslibrary的官方网站上申请 图书卡账号密码
--无限时登录WiFi
--每天1小时的电脑使用时间
--打印需要付费(15美分一张)
--不可以借书

完整版本的图书卡可与工作人员联系,需证件(或者50美元一年的费用)。建议自带笔
记本电脑。

交通

罗斯福大道和缅街交界处为曼哈顿至法拉盛7号地铁的终点站”mian st,flushing“
以及各类巴士站。

地铁卡可在地铁站购买,一次2.75美元,可通用用来坐公交车。一次充值40美元有优惠
。$112/月,则无限制使用。注意纽约地铁的 local 和 express 区别,local每站都停
,express则不是而且在高峰期车次多,非高峰期车次少。有些公交车是上车前,在站
前的机器刷地铁卡拿收据。有些则是 上车刷卡。7号地铁半小时可到曼哈顿。

个人经验感受:

如果从中国国内来美国,可先在airbnb或电脑检索“法拉盛、家庭旅馆”,预订房间(
前述$30-50/天)住几天,然后在法拉盛当地看房后再长租。落地第二天去办银行卡以
及电话卡,地铁卡。周围都是说中文的亚洲面孔,完全不用担心语言障碍。

选择机场最好是肯尼迪机场(JFK),拉瓜迪尔(LGA)机场。

美国来纽约选择拉瓜迪尔机场,就在旁边 无论地铁还是巴士还是打车就几站路。

中国来美国选择肯尼迪机场,打车费用大约24-35美元(叫华人华语粤语台语英语服务
的出租公司:新金马(24小时服务电话:718-359-6666)和中华电招车(718-492-8888
)接送快捷,车体干净,根据人数和行李件数选择有不同大小车型、小费按10-15%给即
可。也有巴士地铁选择。

带好笔记本电脑,可以在图书馆使用。

每顿饭(在外吃)的费用大约3-10美元。尤其早餐,豆浆、豆脑、稀饭、油条包子等,
应有尽有,快捷方便。

日常百货、文具电器以及衣物都可在法拉盛买到。

图书馆账号在来纽约之前就可以申请,哪怕没有WiFi 没有电话卡,也可在图书馆登录
WiFi。

附近有健身房以及电影院。

洗衣房,随处可见,1.5美元~3美元 一次,烘干25美分8分钟(冬天衣物大约烘干需要
3个25美分,投币或者刷卡),洗衣液可从洗衣房买,小份或者一瓶,或自带。大型公
寓楼则有地下室洗衣房。

剪发付小费,男女大约都6~12美元一次。另加小费。

银行在缅街上很多家,办卡可用中国护照,柜员会说中文。甚至,汇丰、渣打、中国银
行、中国商行(与国内的账户无关!)等。卡会寄给你的住址,时间1-2星期。

电话卡
随意找一家店,有多种选择。(无线拨打中国国内、美国,无线短信,有限高速流量)。

天气温度
冬天大约有几天的暴风雪,其余温度在保持在1-8摄氏度左右。室外普通羽绒服基本上
即可。(伞可在超市,99分店购买)。住处的室内一般是太热了,短袖短裤。

某些中国超市不超过10美元不能刷卡。小餐馆有些只收现金,也有可以刷卡的。看门上
标记可知收信用卡与否或进去问明。

美元的硬币,分为25美分(Quarter dollar,最常用),1分、5分、10美分、等。

洗衣房投币用的是25美分,可以在洗衣房置换。

在另一个华人亚裔居住集中地,离机场和法拉盛很近的区:Elmhurst ,生活水平也基本
类似。与曼哈顿的地铁交通线更多(7、E、F、M、R)。

当然,何医生的助理,Lisa会事先交流时根据进修见实习地点、内容,给予介绍和适当
的建议。

何医生嘱咐:除非自己需要考试的复习资料,医学专业书籍不必带。他可以提供相应的
专业书籍和图谱,加之网络上各类资料,完全可以满足需要。



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





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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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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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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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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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此主题相关图片如下:

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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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