Community Based Residency Programs

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Juan Rosai

Juan Rosai

New Member
10+ Year Member
15+ Year Member
Joined
Sep 28, 2005
Messages
1
Reaction score
0
Where do you guys think the best community based pathology residency program is? I'm pretty sick of academia right now with emphasis on research and scut work. I'm looking for a program with great one-on-one teaching where practical community pathology is emphasized and you don't have to spend 16 hours a day grossing and begging fellows for cases. I've heard Penrose-St. Francis Hospital in Colorado Springs is supposed to be top notch program. Does anyone know anything about this program. Can anyone recommend any others? Thanks
Members don't see this ad.
 
Dont you know ROSAI HATES "Scut Work"


:D
 
Members don't see this ad :)
Hey dude, AWESOME user name and avatar! That's hillarious.

Since you asked about Penrose-St. Francis....I know a lot about Penrose because I am a resident there. I really like it a lot, and feel that I am getting a great education there. The teaching is great. The hours are good. We're not kept there until all hours of the night grossing but we still have a very substantial case load... enough for a good mix of cases. We do tons of bone marrows (if you like that sort of thing!) There are also nice perks like free food for residents and free parking.

I wish I could tell you about other community programs, but the only one I really know anything about is Penrose. I will send you a PM with more detailed info. Please let me know if there is anything more you'd like me to tell you about the program.
 
Hey Juan I would be really careful about community programs in path. I really think path, like radiology, is a field that benefits from an academic environment for many reasons. I'm just a 4th year applying this year, so maybe I don't know what I'm talking about, but personally I did not apply to any community programs because I just would not be willing to go to one. I'd rather scramble or take a year off and reapply if it came to that. I don't doubt that there are a few community programs out there that do a good job, but on the whole I believe the training is inferior to even an average academic program. You may be "sick of academia" but you've got to get solid training or it will show when you're a practicing pathologist and will follow you around for the rest of your career. Just my 2 cents...
 
Univ Tenn in Knoxville is more like a community program than a University one.

Though, I expect if you are not careful you can get just as much "scut" in a community program as a University based program. And, programs can change dramatically from year to year depending on the turn over of support personel.

I personally think you can get a decent education in practically any path program as long as you take control of your own education. Even the best programs have areas where the training is not so good.
 
ChipLeader said:
Hey Juan I would be really careful about community programs in path. I really think path, like radiology, is a field that benefits from an academic environment for many reasons. I'm just a 4th year applying this year, so maybe I don't know what I'm talking about, but personally I did not apply to any community programs because I just would not be willing to go to one. I'd rather scramble or take a year off and reapply if it came to that. I don't doubt that there are a few community programs out there that do a good job, but on the whole I believe the training is inferior to even an average academic program. You may be "sick of academia" but you've got to get solid training or it will show when you're a practicing pathologist and will follow you around for the rest of your career. Just my 2 cents...
Click to expand...

I really couldn't disagree with you more on this one. At my community program, we get one on one teaching from our attendings on a daily basis. Actually sitting at the double head for the entire day with just one resident, and one attending. We do not have to beg for "sloppy seconds" from fellows, nor is teaching trickled down through upper level residents.

It's ironic that you mention the need to get solid training as a reason NOT to go to a community program. Here is a story for you:

When I was a fourth year medical student, I told the pathology department chair at my med school (who, incidentally, is an extremely well connected guy who trained at Hopkins) which programs I was considering. He told me that between my top two choices (one was Penrose, and the other was a large university-based program), I should most definitely choose Penrose because the he knew it was really solid, and he felt that the pathology training at the large academic institution was "not so hot". His exact words were: "If I were you, I would choose to go to a program were you will learn to be a good pathologist. I know that at Penrose, they will train you to be a good pathologist. I have my doubts about University of X. They have great research there, and if you are planning on doing lots of research in your career, maybe it would be a good fit. But remember, just because there is a lot of research there does not necessarily mean they'll teach you to be a good pathologist."

After doing externships at both these places, I saw what he was talking about. At Penrose, I got plenty of really good teaching at the scope. At the university program, I was ignored for the entire week when I was assigned to Heme (as was the resident I was with, who chased the Hemepath attending around like a puppy desperate for some attention from its owner). At Penrose, all the residents were happy and confident in their training. At the university program, several (three, to be exact) residents told me that they didn't really feel the training they were getting was very good. Major red flags.

I realize this is only one example. I admitted earlier that I don't know anything at all about other community programs. Perhaps we are truly an anomaly, I don't know. You did offer the caveat that "a few" might offer good training. Maybe mine is one of the few. I just get a little riled up by the sweeping generalization that community programs offer inferior training, because I know for a fact that's not true in our case. That is all.
 
I guess my program is also considered a community based program because we are not affiliated with a major university. I am at Baylor in Dallas, and what Weil-Felix said is true: you get one on one time with the faculty when signing out, we don't fight with fellows for cases and we don't do scut. We have a PA to help us gross which makes our hours reasonable and conducive to learning (book reading). Our heme service does 8-9 bone marrows a day. Where i did medical school, we had 2 heme fellows and did 2 bone marrows max a day (if that). I don't want to go into academics, so this is the right place for me. You can still do research if you want. And they treat us really really well here. So ChipLeader, I would have to say with your attitude, you probably wouldn't be happy at a place like this. You may be someone who needs scut and grossing 4-5 colons a day to be happy.
 
I second the notion that just because a program is academic doesn't necessarily imply better teaching. On my interview trails I saw a few programs where the teaching did not seem to be a priority. You have to evaluate each program you see individually, as well as listen to people who have trained there in the past or are currently training there. Most programs would be happy to give you email addresses of recent graduates if you like, and they are less likely to be biased, and may give you more info that you are looking for.

Personally, I wanted a path training program where I would learn diagnostics. Research is nice, and being involved in a few projects is definitely good for education. But the purpose of residency is to learn to be a good pathologist (at least for me) and not to learn how to do research or to get my name on a paper with Dr X.
 
yaah said:
I second the notion that just because a program is academic doesn't necessarily imply better teaching.
Click to expand...

I would go a step further, I think the best academic research focused programs are some of the worst training programs for community pathology practice. Im feeling this at the moment first hand.

I could diagnose synovial sarcs and pontificate all day on microarray analysis of diffuse large B-cell lymphomas and all that crap isnt helping with all the FNA/Bone marrow procedures Im doing that no one ever bothered fricking teaching me.
 
Okay then, I'll defer to the more experienced peeps on this board. Like I said, I'm just a 4th year med-student so what do I know :oops: . Anyway didnt mean to offend anybody at a community program...I guess if you pass your boards and are committed to keeping up with relevant advances in the field that's all that matters as far as being a good community-practice pathologist. Personally I prefer to go to an academic program, but that's just me...Good luck wherever you end up Juan.
 
Finding a residency program is like a marriage - it's not so much what's right or wrong about the program, it's what the individual resident-to-be wants out of their training.

At one extreme you have the big-league academic playas that are obviously going to de-emphasize what is for the purposes of this discussion called "community practice"-geared training, in their goal of advancing the boundaries of current knowledge.
At the other extreme you have the so-called "grassroots" pathologists doing and reading their own fine needle aspirations and bone marrow biopsies.

Both practice styles are important - and so is everything in between.

Different applicants are naturally going to be attracted to different programs.

What this discussion really highlights is that you have to find the practice style that fits you and your goals, and that is what your application and interview (and of course residency training) is going to be geared towards.

And because I believe in what I am saying here, I chose to come to Minnesota where I felt I would gain exposure to "everything in between" :)
 
Members don't see this ad :)
deschutes said:
Finding a residency program is like a marriage - it's not so much what's right or wrong about the program, it's what the individual resident-to-be wants out of their training.

At one extreme you have the big-league academic playas that are obviously going to de-emphasize what is for the purposes of this discussion called "community practice"-geared training, in their goal of advancing the boundaries of current knowledge.
At the other extreme you have the so-called "grassroots" pathologists doing and reading their own fine needle aspirations and bone marrow biopsies.

Both practice styles are important - and so is everything in between.

Different applicants are naturally going to be attracted to different programs.

What this discussion really highlights is that you have to find the practice style that fits you and your goals, and that is what your application and interview (and of course residency training) is going to be geared towards.

And because I believe in what I am saying here, I chose to come to Minnesota where I felt I would gain exposure to "everything in between" :)
Click to expand...

The biggest problem with your thinking is assuming everyone has a clear idea of what they want and those traits are somehow appropriately conveyed in a half day visit to a program after flying the flipping red eye in from the opposite coast. You get there after having sat next to an uncomfortably obese woman who keeps putting her arm on your frickin arm rest, you fight through airport security, show up at some ass AM conference where you dont know crap and god forbid some assmonkey junior attending calls on you because you are there looking like a tool in a business suit (read: easy mark). Then a series of interviews where like 1/2 will be with dunghole research types because anyone doing surg path has better things to do than meet with 100+ scut biotch-to-be's that are paraded through each fall. You get a crappy cafeteria lunch, stale chips and an outdated cookie, if you are lucky then meet with the chairman who says "rah rah we own." Then back on the plane sitting next to another overweight American....

And somehow you are supposed to find a "marriage" in all that??

Be honest! 99% of us are status ******, pure and simple, we will go to the best most prestigous program that has the overall greatest chance of impressing that blonde at the local bar into dropping her panties...
 
LADoc00 said:
The biggest problem with your thinking is assuming everyone has a clear idea of what they want and those traits are somehow appropriately conveyed in a half day visit to a program after flying the flipping red eye in from the opposite coast. You get there after having sat next to an uncomfortably obese woman who keeps putting her arm on your frickin arm rest, you fight through airport security, show up at some ass AM conference where you dont know crap and god forbid some assmonkey junior attending calls on you because you are there looking like a tool in a business suit (read: easy mark). Then a series of interviews where like 1/2 will be with dunghole research types because anyone doing surg path has better things to do than meet with 100+ scut biotch-to-be's that are paraded through each fall. You get a crappy cafeteria lunch, stale chips and an outdated cookie, if you are lucky then meet with the chairman who says "rah rah we own." Then back on the plane sitting next to another overweight American....

And somehow you are supposed to find a "marriage" in all that??

Be honest! 99% of us are status ******, pure and simple, we will go to the best most prestigous program that has the overall greatest chance of impressing that blonde at the local bar into dropping her panties...
Click to expand...

perfectly said. :D
 
LADoc00 said:
The biggest problem with your thinking is assuming everyone has a clear idea of what they want and those traits are somehow appropriately conveyed in a half day visit to a program after flying the flipping red eye in from the opposite coast.

And somehow you are supposed to find a "marriage" in all that??

Be honest! 99% of us are status ******, pure and simple, we will go to the best most prestigous program that has the overall greatest chance of impressing that blonde at the local bar into dropping her panties...
Click to expand...
Well then, don't be surprised if your "marriage" turns out not quite what you expect ;) At least you acknowledge some part in the outcome, which really is all my post ever hoped to achieve. I'm glad to see we agree.
 
You get a crappy cafeteria lunch, stale chips and an outdated cookie, if you are lucky then meet with the chairman who says "rah rah we own."
Click to expand...

At Baylor we give you a better lunch than that. I have to admit, they took me out to a really nice place. They were also upfront about the program and said if you want to go into academics this is probably not the place for you, if you want to be trained to be a great community pathologist, then this is the right place.

That being said, last year one of our residents got a fellowship at md anderson, two of our residents this year are got fellowships in san antonio doing cytopath and blood bank, so you are in line for fellowships as well.
 
For better or worse, the bit about most of us being status ****** is pretty much right on. In addition to getting women to drop their panties :cool: , prestigious programs open more doors for fellowships and job offers. Whether it should or not is another matter, but I think name does matter. It's not everything, but it does matter.


LADOC - If you're doing FNAs and bone marrows I'd assume you've done a cytopath or hemepath fellowship. You're telling me you got no training in these procedures during the fellowship? I don't buy the line that academic programs don't teach skills relevant to day-to-day pathology practice, but I guess I'll find out soon...
 
Weil and Pingu

Whats the volume per year at your respective locations? When signing out surgicals about how many trays are you assigned? Is there a reccomended # of treys per level of PGY? What kinds of cases do you think your location sees generaly more of (GI, Breast, heme, etc)?

Just wondering trying to compare to some other places.
Thanks :luck:
 
LADOC - If you're doing FNAs and bone marrows I'd assume you've done a cytopath or hemepath fellowship. You're telling me you got no training in these procedures during the fellowship? I don't buy the line that academic programs don't teach skills relevant to day-to-day pathology practice, but I guess I'll find out soon...[/QUOTE]


At this point your pretty much buying what anyone is selling you with out the benefit of a full test drive. :luck:
 
Surgical volumes, I'm not totally sure. At least 20,000 actual gross specimens, no including cyto or anything like that. I'm sure it's more than 20,000 though. Trays per day I would say 8-9. We see breast, lung, gi, uteri, colons (yuck), kidney, plenty of everything. I'm sure our CP isn't as strong as other programs, but who does have strong CP? There is no recommended amount of trays, you get the trays assigned to you for your particular micro day. They aren't broken down into breast only or anything so you look at a variety of things throughout the day, much as you would do in the community. I would say, though, we see a buttload of heme (from what I hear) 8-9 marrows a day. That's 4 times more than my medical school did and we had 2 fellows.

I had a tray yesterday with a patient with breast cancer and a lung nodule with region 7 and 8 lymph nodes taken. The lung was adeno and we ran a TTF1 to make sure it wasn't coming from her breast. The lymph nodes looked hyperplastic so we ran immunos and it turned out to be follicular lymphoma. To me, that's a heck of a case.

I would also say our faculty and residents are great. There were programs i interviewed at that i could immediately identify people I would clash with. Here we all get along and go out to happy hour. I would have to say that is crucial in your training because if you don't like who you are with, it's going to be a LONG 4 years
 
Pingu
thanks for the info just wondering do the 8 per day include biopsies? and how do your surgical rotations work? every day do a little of everything (frozen, grosss and sign out) or do you have designated days for grossing and sign out?
 
ChipLeader - for what it's worth, doing FNAs and bone marrows doesn't necessarily equal doing a cytopath or hemepath fellowship. Where I'm at, the residents do both. The fellows only get called if the resident is having difficulties.

U of MN is a bone marrow transplant centre, so we do get 8-9 marrows per day, some with pretty whacked-out stories. Of these usually a third to half are "we do"s.

I'm sure we aren't the only program that does things this way, so ask questions on your interview trail if this is something that particularly interests you.

I didn't really care either way - the opportunity to meet patients and the technical satisfaction of getting a good core is nice to have, but I wouldn't be heart-broken if I never did another bone marrow biopsy.

That patient this morning was totally cute though :love:
 
beary said:
What? Why do you want this? :p
Click to expand...
Trust me, it's hugely different when you don't follow their vitals, their labs, their issues and plans... :barf: Like I said, I don't crave patient contact, but I'm trying to see it from the perspective of someone who WANTS to do BMBs and FNAs.

Then again, if you saw my guy this morning, you might understand :p Toughest bones I've ever had to work on (young fellow), but even the fellow agreed he was hot.

The fact that he's getting a bone marrow biopsy though... :oops:
 
McFadden,

We have 20,000 surgical specimens per year. As far as reading out, there really aren't any set in stone rules. It totally depends on what attending you are working with, and what arrangement you personally are comfortable with. First years generally start out just reading out alongside the attending and maybe only dictating a few easier cases. As a second year, I have been trying to dicatate all the cases I grossed the day before, and then sit down with them afterward and go over all of them. That's been working well for me. Sometimes, there are too many cases for me to do that, though. On busier days (in the interest of time) some attendings prefer to just look at some of the more complicated ones together right off the bat and then I'll just take a few trays (5 or 6). Other attendings might take some of the simpler cases (like GI polyps and gallbladders) and let me tackle the larger cancer cases. Really, the attendings will try to let you learn in the way you feel most comfortable, although as you progress through your training, they do expect you to get more independent when it comes to reading out cases.

On surg path rotations, we usually either gross M,W,F and read out T,TH or else its read M,W,F and gross T, TH. Most of the time you are also doing frozens on your grossing days. Number of frozens are quite varied. It seems like most of the time I have have between 2 and 5 a day, athough some rare days there are none, and I think a few times I have had more than 5. I don't really keep track, though!

We see a wide variety of cases. A little of everything, really. Lots of breast, GI, kidney. Quite a few skins,too. No peds cases at our location. Most residents go up to Denver for their peds rotation. One of the biggest strengths of the program is our hemepath training. We do tons of bone marrows, which we perform ourselves. In the two months I have done so far of heme, I performed probably 80-90 bone marrows. We also have an on site flow department, which (from what I understand) is fairly unusual for a community hospital.
 
Weil and Pingu

Thanks for the info

It seems like the mid west and west coast do alot of BMB's, Here on the East coast the Heme/onc guys do the majority of the procedures I havent done a heme path rotation yet but if one presses the issue here (i plan on it) you can perform your fair share. We have alot of frozens to do here while we gross our large cases on grossing day. We had about 9 the other day most of them had multiple parts, but we also go and interact frequently with the surgery team ( good communication not alot of stuck up BS)which helps alot out with that aspect of future community practice. The volume here is good around 45,000 surg and 100,00 cyto specimines divided amoung 12 of us and a couple of fellows. I personally like the fact that if you work hard you get a good feel of what it is going to be like in a community private practice, and even handle a high volume job. We have a peds hosp next door where as first years we do alot of. The attendings here are great and I also have the luxury of alot of one on one signout. I feel that it make learning easier and faster with out alot of guess work and confusion.

I was wondering what kind of career practice setting you guys are planning on going in to? Do you guys have any research intrests at your programs or is that put on the back burner?
Did you ever consider a large University program and what made you decide against it? (not asking for names here just Big Uni X)
Its nice to see what others programs are like that are similar to mine,
Thanks again :luck:
 
ChipLeader said:
For better or worse, the bit about most of us being status ****** is pretty much right on. In addition to getting women to drop their panties :cool: , prestigious programs open more doors for fellowships and job offers. Whether it should or not is another matter, but I think name does matter. It's not everything, but it does matter.

I agree with you ChipLeader to a degree about prestigious programs, but you (when i say you I mean anyone in general) can go to the best program in the world and if you eval letters and reccomendations suck because you are hard to work with or are an A hole, you wont get that fellowship or great job you want. And like pingu said if your environment sucks you will ultimately suffer. I have a freind in private practice who was concerned with hireing a collegue freind of hers because that person spent most of their training in academia and was not used to high volume per person and service time demand and regular specimines. Just make sure when you choose a place that in 4 years you can leave there with out many questions about how to do you job, and feel lucky if you can say that and get some research done as well. :luck:
Click to expand...
 
To answer your questions: I haven't decided what kind of practice I want to be in. I still have some time to decide! I did consider a University program for residency, as I mentioned in one of my previous posts. Research is obviously not emphasized at my program as much as it is at a university program, but if one is interested, there are definitely research projects available. McFaddens, you said you are a first year at a community program. Would you mind sharing which program you are at?
 
LADoc00 said:
Be honest! 99% of us are status ******, pure and simple, we will go to the best most prestigous program that has the overall greatest chance of impressing that blonde at the local bar into dropping her panties...
Click to expand...
Agreed. But my true opinions on this matter is best reserved for bar talk with my homies.
 
ChipLeader said:
Oh really? :laugh: (Sorry, couldn't resist) :D
Click to expand...
Plural, kiddo, not singular! :p You get a cookie - I didn't see that one coming.

I was thinking about this thread while doing the dishes and came up with a few more things to add:

What I really liked (and still like) about having SDN is that it gives you a chance to hear all sorts of opinions (not necessarily positive) about the sheer variety of programs and practices out there. Grouses keep things real.

My program encompasses a university hospital, county hospital, private hospital and the VA. I was a little worried at first when making my rank list because the program is so large physically that it is difficult to get a sense of what it is like on one visit.

(Everyone likes to refer to surg path caseload so I will mention that it was 42k surgicals per year at last count. Someone is then going to ask how this is divided amongst residents, so I am also going to say we have 6 PGY-1s - do the math. Yes it is a large program spread across several sites and for heaven's sake don't ask me about resident camaraderie... come see for yourself if you're interested!

The key point as one program director said, there really is no need for every single resident to look at every single gallbladder that goes by. What is important is that the catchment is available for resident teaching.)

I'm finishing up my 3rd month of hemepath (first rotation of first year) at the university hospital and plan to do my remaining months electively at the county hospital in a year or two. I was encouraged to do this by the attendings.

At Hennepin County Medical Center you're THE hemepath resident. Lymph nodes. Body fluids. HgB electrophoreses. And the regular BMBs and blood smears. High volume diagnostics, a lot different from my current university hospital BMBx/bloods workday.

Lastly, a word about prestigious programs and fellowships/job offers. I understand why people are concerned about this, which is why I said it is important to know what you want. Yes, having a name behind you matters, but less than you think. Like mcfaddens says, if you train at big name research-oriented program and end up going to private practice, there's going to be a mismatch in your skillsets. Even then, it is a mismatch and not an impossibility.

I could quite easily go around saying "HA you didn't get into < insert big name institution here > you're SUNK!! MUAHHAHAHAHAHAHAH LOSER!!!!"
But there are enough people doing that so I'll pass. :D
 
deschutes said:
See, I was right about the beer part :p
Click to expand...
Well, when you're throwing a few back with friends and colleagues, you can be more liberal when expressing opinions. Here, on the other hand, you need to be a bit more careful. You can bitch about things too and that's therapeutic.
 
Dude, go ahead and perpetuate the paranoia, but I was referring to any moving object + beer = homie ;)

And I promise that this is the end of my part in this derailment!
 
Once again down goes another informative thread with pointless jibber jabber :thumbdown:

guys ever heard of a phone for this kind of garbage
 
i set wonderful examples
havent u read any of my insiteful threads
at least i tell it how it is :) :D
 
excatly as i said i tell it how it is
your piont Dumba$$
 
here maybe this might be a little more up your ally
 

Attachments

  • images.jpg
    images.jpg
    2.4 KB · Views: 51
come on andy it cant get any worse
this is like thread # 500K thats been messed up with small talk
at least Banannaface hasent chimed in yet about.....
well more pointless garbage that has nothing to do with pathology or the topic of this thread
 
deschutes said:
Forgive us DasN, perhaps you can set us a better example...? ;)
Click to expand...


I love it when you get all self richeous!!!!!!!!!!!!
You must be perfect :thumbdown:
 
DasN said:
come on andy it cant get any worse
this is like thread # 500K thats been messed up with small talk
at least Banannaface hasent chimed in yet about.....
well more pointless garbage that has nothing to do with pathology or the topic of this thread
Click to expand...
my point was somewhat related to the thread. i do hold opinions on this topic but i don't express them because i know i'll piss ppl off...opinions better expressed in person rather on some online forum. but yeah, this thread did get sidetracked here.
 
I agree totally
It WAS a great thread, a topic not often touched upon
YOu should go ahead and post if it was related
I enjoy your opinions when they are related to the topic
The side tracking just gets out of hand, i know its fun but not all of the time
sometimes its weeks before anything substantial is put on this board
such a great resource should not be wasted
 
especially when the great Juan Rosai started the thread
 
You must log in or register to reply here.
Next unread thread

Similar threads

H
Molecular pathology in community hospital
Replies
0
Views
500
homer315
H
U
Autopsies in the COVID era (community based hospital groups)
Replies
14
Views
3K
LADoc00
LADoc00
P
A joke....that feels all too real based on how our sub-specialty is viewed by other clinicians
Replies
9
Views
4K
ThatSerb
ThatSerb
P
Rank list help: How would you rank these residency programs
Replies
11
Views
2K
deleted314957
D
pathres9999
  • Poll
Glut of Bad Programs and CAP
2
Replies
85
Views
9K
Iceman24
I
Top