cp training in residency

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It seems to me that cp training in residency is a joke...residents either do nothing or waste time observing techs, and dont get enough experience doing "real world" cp duties. As a result, I have become increasingly frustrated with cp. I am more AP oriented in general, but am really only doing cp because it seems necessary to secure a non-academic job.

For those who may have felt the same way at some point, what has your real world experience been like in terms of cp? Is it possible to land a good non academic job with minimal or no cp? If you do cp, what % of time is it compared to AP duties? Did you feel prepared based on your residency training (right now I am terrified at the thought of being 'medical director" of some laboratory).

Also, is it possible to do well on boards if one only studies the compendium and compendium companion. As my interests are, I would rather spend my time in residency mastering surg path and cyto and only learn enough cp to pass boards.

Yup CP training at most places is a joke. It is like a minivacation. Unless you are at a large academic center with a busy lab, CP training seems to be reading out of a book. I guess you can always make the best out of your situation by hanging out with supervisors and asking them to teach you a thing or two about managing their section of the lab. From reading SDN, it seems like you are going to learn on the job. It really seems like you study CP just to pass the boards.

I am in the same boat as you. If anything master surgpath, cytopath (from what I hear you can learn it on the job as well) and heme. Those areas are most important IMO.

My CP training was hit or miss. Some areas were really good and the residents were really involved. Other areas were basically vacation time, which I didnt really mind to be honest. For the boards, if you know the clinical compendium, you are 90% on your way to a pass IMO. Dont bother trying to read Henry unless you like torturing yourself. Ask the fellows in your institution who have passed the boards how to supplement the compendium in order to pass.

As for my current position, while technically I could be called for CP questions, in practice I never have. I am basically doing only AP in private practice.

There's just a handfull of good CP training programs out there.

At my institution, year 3 is 100% CP. Everything is hands on and you take call on all services. The transfusion/pheresis service call regularly requires you to come in overnight for procedures or help with blood bank services.
/Even with all that, CP is probably the cushiest residency anyone could ever hope for.

Originally Posted by gbwillner

There's just a handfull of good CP training programs out there.

At my institution, year 3 is 100% CP. Everything is hands on and you take call on all services. The transfusion/pheresis service call regularly requires you to come in overnight for procedures or help with blood bank services.
/Even with all that, CP is probably the cushiest residency anyone could ever hope for.

I would agree. Being on CP is the easiest residency. LOL. Anyone know the national pass rate for CP boards? I was told by a resident in another program it was mid 70%

Originally Posted by sohsie

My CP training was hit or miss. Some areas were really good and the residents were really involved. Other areas were basically vacation time, which I didnt really mind to be honest. For the boards, if you know the clinical compendium, you are 90% on your way to a pass IMO. Dont bother trying to read Henry unless you like torturing yourself. Ask the fellows in your institution who have passed the boards how to supplement the compendium in order to pass.

As for my current position, while technically I could be called for CP questions, in practice I never have. I am basically doing only AP in private practice.

Henry is the most fundamental text of clinical pathology. You should be very familiar with it and steering someone away from that book is just dumb. Job-wise your main involvement with CP is usually supervisory, QA and troubleshooting with your techs/managers +/- PhD's doing the day-to-day work but you need to understand what they're doing down there and how. You'll figure out how to function and apply your knowledge on the job as situations arise. But you need the knowledge base and thought process to answer clinicians questions/ concerns and to direct your techs. The more common CP daily issues come from BB and coag in my experience- the clinical impact of those areas you should pay attention to. Micro practically never affects you. That knowledge you just need for CP boards because the test is dumb and doesnt discriminate useful from meaningless esoteria. If you are solid with the CP compendium material you're on good footing for CP boards but it isnt enough and should be utilized more as review.

I concur that CP is the pits at most training institutions, I think blood bank was good at my residency, chemistry was non-existant and cytogenetics was superb. Lab management was also a fairy tale that might have been markedly useful in residency training. I would hammer micro hard because in private practice the two things I have to deal with (call wise) most regularly are blood bank and micro type questions (i.e. MD calling asking what they should do).

I think in residency you should probably focus on reading because most CP is knowledge of what to do with results, what to guide the treating MD with labwise. Usually, most clincial related quesetions are straightforward (recently I got called by some MD asking how to diagnosis myeloma). I have been blessed with having experienced supervisors that have really limited the amount of b.s. calls/questions that I get. I never saw how apheresis would be useful to a resident unless you were going to be a blood banker as most pathologists do not do this, probably one of the things "to do in residency and move on." At my lab we also interpret clincial labs (some insurance companies do reimburse for these), but I know many pathologists who live an AP existence and are available for rare CP questions. I would recommend doing AP/CP because its what many look for in hires, I would imagine it would be a markedly big lab to hire CP only pathologists (if CP only and pathologist can go in the same sentence in a traditional sense - maybe I am biased).

What you need to know in general private practice for CP can be learned in a few months - a little blood bank, a little coag, CAP regulations, etc. There is well over 1 year of wasted CP time in an AP/CP residency, wasted time which is well over a year of lost income. AP/CP residency should be 3 years, and then fellowship/job. Either that or at least 3 years AP and 1 year CP, not 2 and 2.

It doesn't have to be a joke - many programs don't do a good job but almost all of them have the resources if you want to make the most out of it. Most people know that residents don't care much so they won't put the effort forward to engage you more than a little. But if you engage them and look for opportunities to learn they will be there. Seek out lab managers, administrators, etc, not just the faculty. Learn about accreditation, QA, QC, bringing up new assays, things like that.

Originally Posted by 2121115

What you need to know in general private practice for CP can be learned in a few months - a little blood bank, a little coag, CAP regulations, etc. There is well over 1 year of wasted CP time in an AP/CP residency, wasted time which is well over a year of lost income. AP/CP residency should be 3 years, and then fellowship/job. Either that or at least 3 years AP and 1 year CP, not 2 and 2.

How about 1 year clinical + 4 years AP like most places in Canada?

To take perhaps the cynical view, one generally doesn't do much on CP rotations because there isn't much to do. Lab directors individually just -don't- do much, certainly not much relevant to the board exam, a few subspecialties or idividuals excepted. Many of those things have largely been handed over to the techs, who are almost never paid more to teach you so often aren't particularly interested in doing so. Most of the testing, results, QA, and so on are validated, standardized, and technical. There isn't much which one can bill for interpreting, and in many instances it probably wouldn't add much. PhD and non pathology directors have other interests and little concept of what you need to learn or do in order to succeed. Not only that, they may have less oomph in administrative meetings, being all the more overshadowed by the wants of clinical specialties. In other words, CP training is generally lackluster or text heavy because that's what the job has become.

As for lab administration, that also falls under AP. But since most departments are not administered internally or by the pathologists (at least not those who teach or interact much with residents), and even the lab/medical directors are only peas in a pod including the MBAs, residents are naturally excluded. The non-pathologist/non-physician admins in particular appear to delight in excluding physicians, keeping their secrets, and playing politics behind the scenes, none of which are conducive to transparent resident teaching. That was one of the good things about spending a couple of years during residency with a private group; there were still a lot of secrets and such, but at least we heard about some and could discuss and learn some at the scope, because the partners still practiced pathology and worked with us on cases.

Here's a question, may not be a good one but still one non the less.

How would it affect an applicant if they were to do only AP and forgo the CP training? Could that be detrimental to employment after residency and a possible fellowship, like say FP fellowship? I ask this as someone interested in mostly doing FP.

That general question has come up before, and while I have to concede that currently too many surg path centered jobs "require" (as per the job listing, not because it's strictly needed to be any "good" or even to cover CP calls, but the difference is moot if you still won't be hired) one to have both AP & CP, that is not the case with forensic path. I know quite a few FP's who were AP only (some intentionally as 3yr AP only, others did the 4yr AP/CP training but never took CP exam, others didn't pass CP the first time and just shrugged it off), and a fair chunk of the new ones who are AP/CP I seriously, seriously doubt will recert in CP at the 10 year mark.

There is definite utility in some of the CP training when it comes to FP, absolutely, but until FP boards require one to also be CP (not currently the case and I doubt it ever will be), then I think there's no particular reason to become CP boarded if your fellowship and job interests are really just forensic. You can still do some CP rotations (or should be able to) but still just do the 3 years for AP only. I get asked in court what my certifications are, and the rare times someone asks what it means in detail I explain and include that CP is above and beyond the requirements for FP. I'm also not aware of any time it was brought up negatively for those AP-only folks, though that's a theoretical possibility and one which -could- come up but can't really preclude you as a boarded FP from being qualified as an expert in FP...which is generally all that needs to be determined from that line of questions. Plenty of people get qualified as FP experts without even being FP boarded, some of them without being AP boarded, but that won't help their consulting careers, if they want one. Fellowships are there and jobs are there (although spread out) for that particular subspecialty, and very, very, very few will request or require CP -- those that will are probably those where the forensic case load is low and you're expected to cross cover other things, but those are by far the exception rather than the rule.

Ah, Thank you

there are LOTS of hospitals that require CP certification to be credentialed on staff.

Originally Posted by sirenomelia

Henry is the most fundamental text of clinical pathology. You should be very familiar with it and steering someone away from that book is just dumb. Job-wise your main involvement with CP is usually supervisory, QA and troubleshooting with your techs/managers +/- PhD's doing the day-to-day work but you need to understand what they're doing down there and how. You'll figure out how to function and apply your knowledge on the job as situations arise. But you need the knowledge base and thought process to answer clinicians questions/ concerns and to direct your techs. The more common CP daily issues come from BB and coag in my experience- the clinical impact of those areas you should pay attention to. Micro practically never affects you. That knowledge you just need for CP boards because the test is dumb and doesnt discriminate useful from meaningless esoteria. If you are solid with the CP compendium material you're on good footing for CP boards but it isnt enough and should be utilized more as review.

Henry is a nice reference book but an awful read and what is dumb is to encourage someone to try to read that thing cover to cover or to use it a primary text to learn CP for the boards. It is an extremely inefficient use of studying time. There are much better books that are more readable and digestable for all of the areas of CP that one might be interested in learning. For instance, why would one bother with Henry for Blood bank when the AABB books are ten times more readable. more current, and more useful. Even if one wants to read a cover everything textbook type CP book, there are much better books than Henry. Waaaay too often I have seen attendings in academic institutions respond to the question "How do I pass the CP boards" with "read Henry." Absolutely not!

BTW, by not reading Henry (I got through about 20 pages and quit), I had a high 600s score on the RISE before I took the boards and I can say that unlike everyone else I know, with one exception, I walked out of the ABP after the end of the CP boards absolutely certain that I had passed. (The one exception was a resident who followed my exact blueprint for studying for CP. He felt exactly the same after the CP boards).

Originally Posted by sohsie

BTW, by not reading Henry (I got through about 20 pages and quit), I had a high 600s score on the RISE before I took the boards and I can say that unlike everyone else I know, with one exception, I walked out of the ABP after the end of the CP boards absolutely certain that I had passed. (The one exception was a resident who followed my exact blueprint for studying for CP. He felt exactly the same after the CP boards).

Mind if I ask what your blueprint was? I'm cramming for CP but feeling pretty overwhelmed. Thanks!

Originally Posted by KCShaw

To take perhaps the cynical view, one generally doesn't do much on CP rotations because there isn't much to do. Lab directors individually just -don't- do much, certainly not much relevant to the board exam, a few subspecialties or idividuals excepted. Many of those things have largely been handed over to the techs, who are almost never paid more to teach you so often aren't particularly interested in doing so. Most of the testing, results, QA, and so on are validated, standardized, and technical. There isn't much which one can bill for interpreting, and in many instances it probably wouldn't add much. PhD and non pathology directors have other interests and little concept of what you need to learn or do in order to succeed. Not only that, they may have less oomph in administrative meetings, being all the more overshadowed by the wants of clinical specialties. In other words, CP training is generally lackluster or text heavy because that's what the job has become.

As for lab administration, that also falls under AP. But since most departments are not administered internally or by the pathologists (at least not those who teach or interact much with residents), and even the lab/medical directors are only peas in a pod including the MBAs, residents are naturally excluded. The non-pathologist/non-physician admins in particular appear to delight in excluding physicians, keeping their secrets, and playing politics behind the scenes, none of which are conducive to transparent resident teaching. That was one of the good things about spending a couple of years during residency with a private group; there were still a lot of secrets and such, but at least we heard about some and could discuss and learn some at the scope, because the partners still practiced pathology and worked with us on cases.

Actually, there is a lot to do. It's just that many training centers are so large that a lot of the tasks are farmed out (Delegated, in admin speak) to various people. The smaller the hospital, the more these tasks are concentrated in fewer hands. THere are some residency programs that really do make an effort. The U of OK, for example, has a several month CP rotation which is based on lab admin and the residents take care of problems that come up from "we have been noticing too many positive tests for assay X" to "I don't understand these test results" to stuff about quality reports. It's just hard to teach this and hard to get residents involved. But it can be done.

Originally Posted by sohsie

Henry is a nice reference book but an awful read and what is dumb is to encourage someone to try to read that thing cover to cover or to use it a primary text to learn CP for the boards. It is an extremely inefficient use of studying time. There are much better books that are more readable and digestable for all of the areas of CP that one might be interested in learning. For instance, why would one bother with Henry for Blood bank when the AABB books are ten times more readable. more current, and more useful. Even if one wants to read a cover everything textbook type CP book, there are much better books than Henry. Waaaay too often I have seen attendings in academic institutions respond to the question "How do I pass the CP boards" with "read Henry." Absolutely not!

BTW, by not reading Henry (I got through about 20 pages and quit), I had a high 600s score on the RISE before I took the boards and I can say that unlike everyone else I know, with one exception, I walked out of the ABP after the end of the CP boards absolutely certain that I had passed. (The one exception was a resident who followed my exact blueprint for studying for CP. He felt exactly the same after the CP boards).

You have no idea what you know or dont know since you stated you dont practice CP. You can probably pass the boards with remembrances and attending and staying awake in conferences and take a review course and reading nothing. One perspective is for a trainee to do the bare minimum to just pass a test, the other is to learn as much as possible and understand this profession and strive to be all around excellent. Henry's isnt a board review book, and residency is a training apprenticeship for laboratory professionals not a four-year board review course.

well at certain assinine programs they just make you do extra grossing during CP months and refuse to assign adequate months of the different cp rotations because they hate you. meanwhile, they give certain people extra months of cp to relax and lounge, and write yet another assinine review about something equally assinine.

people, please don't all pm me at once

Sounds like there is some weird stuff going on at your residency if only certain residents have to gross while on CP rotations...or that you're grossing on CP rotations at all.

also, just FYI - it is "asinine" (although the extra "s" is certainly kinda funny)

Originally Posted by member5000

well at certain assinine programs they just make you do extra grossing during CP months and refuse to assign adequate months of the different cp rotations because they hate you. meanwhile, they give certain people extra months of cp to relax and lounge, and write yet another assinine review about something equally assinine.

people, please don't all pm me at once

You need to report this to ACGME. This can't be good.

Originally Posted by Unty

You need to report this to ACGME. This can't be good.

This one has to go on the list of crappy gross-horse programs that I started a few weeks ago.

If you're an attending you have little to lose by outing such a crap program.

it's already on the list! the most dysfunctional program with a few crazy male leaders who couldn't tell the difference between simple entities if it hit them on their face. of course, they are great schmoozers and know how to promote certain sadistic and incompetent individuals who tout their horn.