What to look for to spot a bad pathology residency program?

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If any residents could share their input as to their experiences, it would be greatly appreciated.

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I'm not sure if this will be any help, but my program is a bit of a sinking ship, and here are some things that I wish I had paid more attention to when interviewing:

First and foremost: are the residents at the program happy? If they are not - find out the reason why. One disgruntled resident may mean nothing, but if an entire program is unhappy, there is probably something wrong.

Secondly, look at the number and variety of specimens coming through the door. Are there pathology assistants who help with the more routine/common specimens? At my program, the residents gross EVERYTHING. Yes, it's important to know how to gross placentas, but I don't think that it's necessary to gross 3+ a day when you are cutting (however, if we didn't gross everything we wouldn't be very busy, because our number if big/interesting cases has dropped way off in the last 2 years). Also at my program we gross all of the biopsies. When I was applying, I thought this might be a good think. It's not. There is NO educational value that comes from pouring little pieces of tissue into tissue bags. Signing out biopsies is educational - grossing them is not.

Also, try to get a feel for the teaching provided to the residents - how many conferences, are they protected time, can the residents attend QA/QC slide review conferences?

Lastly, if a program does not have fellowships (mine does not), then be sure to see how well connected the attendings are and their willingness to go to bat for you when you apply to fellowships in the future.
 
I agree with what the poster above stated.

Make sure the volume is close to the 20,000 mark. I know of a program out there which sees 4-5,000 specimens yearly. :eek::eek::eek: I am sure that residents coming out from this program are not well trained.

Make sure the other residents are happy. Ask them questions. See how they respond.

If you think a program will not train you well (after visiting the program and asking all the questions), then most likely it won't.
 
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I would say at least 15-20k, more is generally better (as long as it isn't 80k galbladders, variety is important)

And evaluating the residents is extremely important, are they happy with where they are, do they get along, would you get along with them?

Programs that restrict your access to residents should be viewed suspiciously..
Ideally you should have time with the residents at some point without attendings present..

Different places have different temperaments, and being at one where you fit in well is always helpful.
 
Thanks. That helps. Any of the little minutia that you could think of that might bother someone or isn't obvious would be great too.

Also, why do some of these programs have programs if they don't receive a minimum number of cases. Shouldn't they have to in order to be considered a teaching institution in that particular residency?

Are there places(websites) that might give me an idea of that info too?
 
Thanks. That helps. Any of the little minutia that you could think of that might bother someone or isn't obvious would be great too.

Also, why do some of these programs have programs if they don't receive a minimum number of cases. Shouldn't they have to in order to be considered a teaching institution in that particular residency?

Are there places(websites) that might give me an idea of that info too?


Lots of places list that info in their freida info..

http://www.pathologytraining.org/
Tends to have the programs self published data if you don't have a copy of the print version handy... Good for getting all the numbers data in one place (size of hospital, PGY pay, # spec)
 
IMO, anything with word "Pathology" in the name...but seriously, Im very disenchanted with the entire academic established with no way to really "vote" these people out of their failboat of a job.
 
I think a lot of talk about "getting the work done" is usually a warning sign. Not to say that you shouldn't work hard, but if it's on the mind of the residents/faculty enough that you hear it repeatedly throughout the interview, it probably means that there is a lot of scut to be done and they don't want someone who won't pull his own weight. Alternatively, if you hear repeatedly that the work volume is "not too bad", it may mean the opposite. (Although if you hear it once I wouldn't be suspicious.) Obviously if there are no PA's of any kind, you will likely be grossing everything as mentioned above.

I might also be alarmed if it seems that many of the residents chose pathology haphazardly. For example, "I didn't like anything else," or "I didn't like my ______ residency and switched to path" [without ever doing a rotation]. This is not a flaw of the residents themselves but perhaps a sign that the program does not attract the more committed residents for some reason (program has flaws apparent to a more critical eye).

Oddly, on my interviews, which spanned a fairly wide geographic area, some programs had no assistance with grossing whatsoever and asserted that it was completely normal and done everywhere. At the same time, at other programs they were shocked to hear of such a thing. I think it may vary somewhat by region.

I agree, as mentioned above, that you will almost always have a grumpy resident or one who thinks everything is scut. Hopefully you can see past that phenomenon during your visit.

I also agree that there is probably an optimal specimen volume where you see an appropriate amount of diverse surgical path cases while not seeing only zebras or working so hard you can't learn/read about anything. (I'm not sure if there is such a thing as a program with too many zebras.)
 
Something a PD told me was that it is public information how often residency programs are being inspected by the ACGME for continued accreditation. Places with a 5 year cycle have no problems, but those being inspected more frequently have some problems. She suggested that for places with a 3 year cycle to ask the PD during the interview why that is and what they're doing about it and not to interview at places with a 2 year cycle.

http://www.acgme.org/adspublic/ --> on the left, search accredited programs --> choose the specialty, state, and program
 
Something a PD told me was that it is public information how often residency programs are being inspected by the ACGME for continued accreditation. Places with a 5 year cycle have no problems, but those being inspected more frequently have some problems. She suggested that for places with a 3 year cycle to ask the PD during the interview why that is and what they're doing about it and not to interview at places with a 2 year cycle.

http://www.acgme.org/adspublic/ --> on the left, search accredited programs --> choose the specialty, state, and program

Interesting....

JHU is on a 0.5 year cycle...

Oh wait that is a typo on ACGME's part.. it is 5 years...
heh..
:smuggrin:
 
My program had multiple problems which were generally not discussed with applicants. The applicants would meet with the residents as a group and the chief resident would go see the program director after the meeting and report if any resident made any negative statements about the program. As you can imagine, this tended to stifle free exchange by the residents.

I would urge all students to protect the identity of residents who give you the straight truth about their program in order to prevent retaliation against these honest residents by faculty.

I agree with most of the red flags stated above. I also think it is very important to find out the program's policy on taking time off for fellowship interviews since fellowships have become more important for the job market. The 48 week average per year rule of the ABP allows 16 weeks off over a 4 year residency but some programs refuse to give you 16 weeks off.
 
My program had multiple problems which were generally not discussed with applicants. The applicants would meet with the residents as a group and the chief resident would go see the program director after the meeting and report if any resident made any negative statements about the program. As you can imagine, this tended to stifle free exchange by the residents.

Wow that is super shady...

My program had the whole lunch with residents thing, and the interviewee got a tour with one resident of the department...
So if you got any of the good residents who told you anything you wanted to know, you were lucky.
If you got the rare resident who didn't like the program/themselves/life then hopefully the lunch gave you a chance to ask other people questions...
 
As an applicant your job is to read between the lines. Senior residents want good junior residents and the program would have to really suck for them to sabotage their chance of working with good people, definitely take negative comments seriously.
 
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Take negative comments seriously but don't overblow them either. I get the sense that some applicants are looking for a fairyland where nothing is ever wrong and everyone is loved, where everyone doesn't have to work hard yet still becomes competent. Doesn't happen. Every program has problems. The ones that are honest about them, and where the residents acknowledge them, are probably more likely to have these problems corrected or at least addressed to some extent. exPCM's comment above gets at this.

Also be very careful when you meet up with one (or two) disgruntled residents who have an axe to grind about something. The best advice about residency interviews is to take every comment you hear with a grain of salt. If you hear the same thing multiple times, it is more likely to be true.

Another thing I would say is to be VERY careful about hearsay. On interviews you will meet residents who ask you where else you were interviewing, and if you say "University X" they might say either that they have heard that program is malignant (they may have even interviewed there themselves), everyone is happy and overworked, etc. While hearsay is important to consider for the purposes of your own evaluation, it should never be taken as gospel (even if it is a positive comment). Rumors are often at least 50% full of crap.

And bear in mind also that like the rest of life, many path residents are either 1) evil people who put on a good front only for people who evaluate or reward them, 2) lazy, 3) clueless, 4) manipulative. I would wager that every program, even among the best ones, has at least one resident and one attending in all four categories, usually more than one. Unfortunately because these traits are often ignored or not weeded out during interviews, these people will become your classmates even if you go to a great program.

As far as how to spot a bad program, this is difficult I think. As said above, specimen volume and diversity as well as a well organized rotation schedule are important so that at least you know you will become competent. It is also important to find out that teaching residents is a priority. If residents spend most of their time grossing small biopsies, it is not a priority. If residents don't get to preview, it is often not a priority. If attendings don't give conferences, it is not a priority. If residents are given the opportunity to present things frequently, it is not a priority. If attendings are always behind a locked door and an armed secretary, it is often not a priority. The purpose of residency is primarily educational, not labor or making the attendings' lives easier. But never forget that part of a quality education INCLUDES HARD WORK.
 
Another thing I would say is to be VERY careful about hearsay. On interviews you will meet residents who ask you where else you were interviewing, and if you say "University X" they might say either that they have heard that program is malignant (they may have even interviewed there themselves), everyone is happy and overworked, etc. While hearsay is important to consider for the purposes of your own evaluation, it should never be taken as gospel (even if it is a positive comment). Rumors are often at least 50% full of crap.

This point cannot be stressed enough. Most of the time, even if the advice that is offered is genuine, it is out of date. Several times on my interview trail, I heard things about a program that wound up reflecting problems or situations anywhere from 1 to 5 years in the past.

The only other situation I encountered was hearing negative things about a particular program from multiple people (at least 5) around the country. Although that program didn't wind up in my top 5 on its merits, it didn't seem as terrible as I'd heard. I was left wondering "If this program is percieved so negatively by so many people, even if it seemed fantastic to me, would I want to train there?" Luckily it didn't wind up in my top 5, so I never had to answer the question.

DBH
 
Programs that restrict your access to residents should be viewed suspiciously..
Ideally you should have time with the residents at some point without attendings present..

.

I've noticed that many places just send you around with the chief resident and I maybe get to waive hi to the lower levels. This seems fishy to me. Anyone else get this feeling?
 
I've noticed that many places just send you around with the chief resident and I maybe get to waive hi to the lower levels. This seems fishy to me. Anyone else get this feeling?

Sure. Although sometimes its an oversight. The first place I interviewed, I met with a lot of facutly, everything was great, but I only had lunch with two residents. I was suspicious - were they hiding them from me? So at the end of the day, I asked if I could meet some more residents. The PD said "Sure!" and took me to the signout room where 4 people dropped what they were doing to tell me how happy they were, etc. It was great. It wound up being my number one choice and where I matched.

So I made sure this year that they included time to mix/mingle with the current residents, so no one gets that impression. If you have a little extra time, and feel like they're hiding them from you, ask if you can meet more residents and see how they respond.

Good luck!

DBH
 
If any residents could share their input as to their experiences, it would be greatly appreciated.

From my experience:

Volume:
No PAs to gross crummy specimens is a sign of a bad program. In general, the more PAs the better. This is because no PAs means you will gross a lot of worthless specimens (too much unnecessary volume)
I also think that that the total number of specimens through the door is irrelevant. A better gauge is how many hours residents gross, and better yet the number of bigs/medium/small specimens residents gross per day.
Total work hours is also important. Some programs are 9-5 M-F... There's just no way you're seeing enough volume, especially if you have conferences. Some programs are 7-10:30... and you may be overworked and miserable. Previewing should be included in your 80hr work week time.

Teaching/Faculty:
How many conferences are there in a given week? How many faculty members are there in the department? Too few is bad. How many "famous" faculty members? Are they accessible?
Are faculty members leaving? Is the program hiring? Is the chairman stepping down? If so, many more faculty member may also leave, turngin the program into a "sinking ship".

Free Food:
I consider free food a bonus factor, and for every day of free food you get per week it should be a multiplier for how much you like the program.:)

Scut:
Do residents spend excessive time doing non-educational tasks, like filing slides/accessioning/acting as a courier? These things are a waste of your time.

Communication:
Conferences- can you go? Are there limits? How much money can you get? Some programs limit you to 1/yr, some let you go as long as you have an abstract submitted, some won't pay. This is your chance to mingle and set-up fellowships...
Program direction- Does the program change in response to resident concerns? Is there an "us vs. them" mentality? Some charimen seem to not care at all about their own department and training....

Fellowships:
How many are there? If your program doesn't have the fellowship you want, you may want to go elsewhere since most programs seem to prefer internal candidates.

Research:
Is there funding readily available? Are the faculty supportive, and recruit you for projects? Do you get a research rotation? If no... well, depends if you are interested in academics.

Bad Vibes:
If you see residents continuously complaining about their program, this is a huge red flag. If a fellow tells you "fellowship here is good, but I wouldn't do my residency here" don't go there.

Basement:
Is the path dept. in the basement? I need windows.
 
I agree with not listening to other people on the interview trail. Several interviewees would say that they didn't like a certain program, but I would like it. Everyone has different opinions. Remember...it's where YOU are going to be for the next 4 years, not somebody else. Also, I got a bad feeling when residents/faculty would speak badly about other programs. I always feel like people that speak negatively about another program might have something to hide themselves. In the end, path isn't uber-competitive and most likely the programs will be fighting over you. This is the time when you can really pick where you want to go. Trust your gut. Of course, no matter where you end up, it's how much effort that you put in that will determine what you get out of it :D
 
I've noticed that many places just send you around with the chief resident and I maybe get to waive hi to the lower levels. This seems fishy to me. Anyone else get this feeling?

Maybe. Do ask if there are "other residents" who aren't too busy to talk to you. If the answer is no, then the amine odor is real. Also, even if the senior residents want to tell you everything, they may be so used to their program, it won't occur to them that X,Y and Z are unusual and might influence (+ or -'ly) the applicant's opinion. These should be fresh in the first-years minds.
 
If any residents could share their input as to their experiences, it would be greatly appreciated.

look for resident friendliness and volume. I had programs I did not even rank due to fact the residents were so strange.
 
look for resident friendliness and volume. I had programs I did not even rank due to fact the residents were so strange.
Wow. You are giving advice to someone who is almost certainly done training. This thread is 6 years old.
 
How to evaluate (or grade) a pathology residency program in one simple flowchart / algorithm:

pathology-residency-grades-criteria-flowchart-algorithm.png
 
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How to evaluate (or grade) a pathology residency program in one simple flowchart / algorithm:

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Sweet chart Rodak. My only disagreement is that I don't think residents should be limited to ONLY previewing cases that they grossed themselves. Where I trained we certainly did preview everything we grossed. However, we also had regular days in our schedule (1-3 per week) in which we would preview and generate reports on cases that we did not have to gross ourselves (PA(s) would have grossed the day before), which I thought was awesome.
 
If you are actually interested in pathology, you'll be happy with whatever program you get so you can practice pathology. Otherwise you should pick another field. Four years can go by very quickly. You need to concentrate on training your mind to read glass and stop whining. If the program is not ideal and you are not being spoon fed, you need to supplement your education on your own with a lot of reading and pushing glass at your desk.
 
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Sweet chart Rodak. My only disagreement is that I don't think residents should be limited to ONLY previewing cases that they grossed themselves. Where I trained we certainly did preview everything we grossed. However, we also had regular days in our schedule (1-3 per week) in which we would preview and generate reports on cases that we did not have to gross ourselves (PA(s) would have grossed the day before), which I thought was awesome.

I agree. Consider my revised scoring system. I dropped the grossing biopsy question because that's ultimately a minor quibble if you are not even responsible for diagnosing cases. Note that your program can't be in the "good" category without suitable surgical pathology responsibility. I understand that residents independently reporting frozens is not legal if the attending bills for it. Some places don't bill for after hours or certain resident-reported frozens. It seems optimal to do that *to some degree* before your first day in the real world. Share freely and please post feedback to make this more useful for resident candidates.
 

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I agree. Consider my revised scoring system. I dropped the grossing biopsy question because that's ultimately a minor quibble if you are not even responsible for diagnosing cases. Note that your program can't be in the "good" category without suitable surgical pathology responsibility. I understand that residents independently reporting frozens is not legal if the attending bills for it. Some places don't bill for after hours or certain resident-reported frozens. It seems optimal to do that *to some degree* before your first day in the real world. Share freely and please post feedback to make this more useful for resident candidates.

Nice work.....
I think this is WAY too CP heavy. I think your score sheet resembles the Boards, where there is an arbitrary scoring system that favors rare and useless things.
 
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