Pathology FAQs

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yaah

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General Questions:

1) What is pathology and why should I care?
Well, pathology is, per many a learned mind, the "study of disease." Path is one of the branches of medicine that serves to make diagnoses and aid in making correct diagnoses. There are two branches, AP (Anatomic Pathology) and CP (Clinical Pathology). The vast majority of residents training in the US do so in a combined residency (detailed below). AP includes surgical pathology, which involves using frozen sections (instant microscopic preparations of tissues) to make diagnoses on OR cases to aid in diagnosis or management (like whether a margin of resection is positive for cancer, or whether a mass is actually cancer or something else). Surg path also involves, obviously, making diagnoses on tissue on traditionally processed tissues (i.e. the next day). Pathologists use the clinical history, gross examination of the specimen, microscopic tests, and occasionally ancillary tests like immunohistochemistry in order to arrive at the correct diagnosis. AP also includes Cytology, using preparations of free cells to arrive at a diagnosis (like a Pap Smear or a needle aspiration of a mass). Residents are trained in performing Fine Needle Aspirations. It also includes Autopsy and forensic pathology. CP includes many lab-based disciplines like clinical chemistry, microbiology, blood banking, coagulation, hematology, immunology, and others. Residents learn how labs are run, how tests are performed, quality control is maintained, etc. Almost every test other doctors order in hospitals goes through pathology who are responsible for the integrity of the results.

Should I do a residency in AP/CP combined or just do one of them if I am interested in only one?
Most residents do combined residency because theoretically (and practically, at least currently) this allows you to have a wider range of expertise when looking for jobs. Pathologists who can not only interpret cytology smears and frozen sections but also can cover blood bank call or ensure quality control in a chem lab are more marketable. This may change, in part, with the increasing specialization of medicine. Generally, people who do straight AP or CP do so with a strong idea of a career in academic medicine (research or combined research and service). The combined residency is 4 years. A straight AP or CP is only 3.

There is also an AP/NP (neuropath) track. You can generally do neuropath as a fellowship after a standard residency, but many people know they want to do this early, and some programs will offer this option.

Pathology DOES NOT require a prelim year in medicine, surgery, or transitional year. You go right to path. Advantage: Pathology.

What is the job market really like?
http://forums.studentdoctor.net/showthread.php?s=&threadid=66690
http://forums.studentdoctor.net/showthread.php?t=85197
http://forums.studentdoctor.net/showthread.php?t=95197
http://forums.studentdoctor.net/showthread.php?s=&threadid=68583
Probably some repeat info here: http://forums.studentdoctor.net/showthread.php?t=115370

How much $$$ do pathologists get paid?
Wrong question!
Sigh…http://forums.studentdoctor.net/showthread.php?t=86495

How do I know if path is the right field for me?
Try it out!
http://forums.studentdoctor.net/showthread.php?t=81071
http://forums.studentdoctor.net/showthread.php?t=82529 (likes and dislikes of other specialties)

Great thread here: http://forums.studentdoctor.net/showthread.php?t=116856


What are fellowships and how do you get them?
Fellowships are similar to any other field. A fellowship is undertaken after the completion of a standard residency and serves as extended training in a specific field. The most common fellowships are general surgical pathology and cytopathology, although fellowships are available in almost anything from specialized areas of surg path (like renal path or GI path) to research-heavy fellowships and CP fellowships. Dermatopath fellowships have the added bonus of getting to compete with dermatologists for spots, because most programs accept both. Some highly specialized fellowships are only available at limited numbers of places. And many programs do not offer fellowships. Generally, residents apply early in their final year of residency (at the very latest) but more commonly during their second to last year, before the regular residency interviews start. In general, fellowships will make you a better pathologist and more competitive for jobs.

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------------RESIDENCY/APPLICATION Q's

What are the best programs?
This is a subjective question and cannot really be accurately answered. The answer will be different for everyone and will depend on geography, area of interest, desired lifestyle, desired methods of teaching/learning, research emphasis, etc. Generally, academic programs are more highly regarded as places that train all-around good pathologists who can be competitive in the job market and the fellowship market. You have to research programs for yourself, and don't trust the biased opinions of everyone, take everyone's impression with a grain of salt. For everyone that hates a certain program, there is probably another who LOVES it. In general, though, many people will recommend training at an academic medical center that sees greater than 20,000 surgical specimens per year and has a record of getting its residents into good fellowships and positions. There are LOTS of good programs out there and unfortunately picking the right one requires lots of research and effort.

http://forums.studentdoctor.net/showthread.php?t=87767

My advice: http://forums.studentdoctor.net/showthread.php?t=115367

What is the residency application process like?
Application is through ERAS like most other fields. Path residency is, currently, not as competitive as many other fields, but it is getting more competitive as people look closer at it during med school as a potential career due to all its advantages. Path residency interviews are usually fairly non-stressful. Oftentimes you are the only applicant there that day. Most interview days consist of interviews with the program director and various staff members, occasionally a resident or two. Generally there is lunch with residents, some programs provide lunch in the department, others will take you out to a restaurant. My experience varied from going on a two hour lunch with two residents to a half hour sitdown in a departmental conference room where various residents showed up for a few minutes here and there. Lunch at one place was with 10 residents and me. At some places, there will be an offer for residents to take you out to dinner the night before, which is always nice. Often you will meet with the chair of the department during the interview, and sometimes this interview is the longest of the day (up to an hour at some locations) or the shortest. The day includes a tour. Usually, it winds up with a meeting with the program director who goes over the residency selection process, the selection criteria, the process the rest of the way, and sometimes includes an assessment of you as a candidate. Following the interview, you will often hear from people in the department. Various things include letters or emails from the program director or others, phone calls from the same people, calls or emails from residents, etc. Many path programs will provide complimentary hotel rooms or other perks for visiting interviewees.

Interviews start getting sent out in mid September, generally. Some programs will invite people for interviews when all they have is the board score and your demographics. Others wait until your application is in various stages of completeness (i.e. transcript, all LORs, Dean's letter, etc). I got the majority of my interview requests before the end of October, but others still trickled in into December. They run from October until February, although programs are different. Some end their interviews in mid January, some don't start until late November or even December. It is best to not assume things based on experience at one single program, and things are likely to change from year to year.

What factors are important in residency selection? Am I a competitive candidate?
This is also a somewhat tough question to answer because it's similar to every other field. Grades are important, board scores, etc. LORs are very important in path because they will often attest to your fitness for completing a pathology residency. It is important when applying to have at least one LOR from a pathologist, preferably an academic one. Even if you don't know the specific person well, if you have rotated through the department and interacted well with others, you can get a great letter. Some people suggest you get more than one letter from a pathologist. Some say that letters from other specialties are helpful. The simple answer is, whoever can write you the best letter. If it's a psychiatrist who can talk about how motivated you are, inquisitive, helpful, hard working, etc, great. I had 3 letters from pathologists plus my dean's letter and that wasn't a drawback. Did it hurt me? I don't know. I doubt it. The personal statement can also help a lot to serve as a tool for interviewers to get to know you and remember you to distinguish you from all the other applicants. It can also bring up topics for discussion or emphasize more of your strong points. Grades are helpful, but in general departments like well rounded residents the best. If your transcript is great but board scores are so-so, LORs are generic, etc, they won't do you much good. Conversely, if one of your spots is weak (like lower but still passing grades) but everything else is good, you will also be fine. Having research experience/publications can also be helpful but again this is not a make-or-break part of the application. It can attest to your intellectual curiosity and experience. You don't have to have a heavy research background (or even any research background) to match at a top program, although it can help to express an interest in it. Board scores are sometimes used to "weed out" candidates at some programs, although on one really knows the actually number. In general, a score at or above average will help you, and a score of passing but below average may hinder you, although if it is isolation, as above, not as much. Step II scores can also help if you do well. Many recommend to take step II later in the year, after you submit ERAS but well before the match. (see next question).

The most important factor, at many programs, is your graduation status. Being a US med school graduate is a big advantage. That is not to say that IMGs cannot match at good residencies, but unfortunately it is often tougher. More hoops to jump through.

Good thread here: http://forums.studentdoctor.net/showthread.php?t=105670

When do I take Step II?
As I said, many recommend you take step II early enough so that if you fail, you can still pass. Plus, there are occasional programs (they will tell you when you apply) who require it in order to rank you. Plus, a good step II score will help you. If you haven't received your score back before you submit your ERAS application, you can choose to decide when to submit your scores, or you can just have them automatically submitted when they are received. So, taking your Step II in November, for example, will let you get your score back in December or January. And if you have already interviewed, it can serve as a good way to reconnect with programs and express an interest in them. Emailing the program director with your good step II score, and oh by the way, I really enjoyed your program, can only help you.

How many programs do I rank?
As many as you want. This advice is the same for any field. It doesn't cost you any more money to rank 10 programs than it does to rank 3, so why not rank 10? Of course, if there are programs where you would rather scramble for a spot than attend them, don't bother. But don't expect a great scramble spot. Last year there were some spots open in the scramble but why would you hope for that? Rank programs in the order you prefer them, NOT in the order in which you think you have a chance. If a program tells you you are a strong candidate, don't just rank them first because you want your first choice. Rank them wherever you rank that program on your list. The satisfaction you get from matching at your #1 doesn't mean much if that wasn't your favorite program. You may always regret not ranking the "reach" program first if you really wanted to go there. Similarly, don't rank a "reach" program #1 just because you want to see if you match there. If you didn't like it, don't. I had a couple of high power programs that I didn't like and didn't rank.

How do you assess which program is right for you?
Again, an individual answer. Ask lots of questions and pay attention on your interview day. Generally, people will be honest with you although they may emphasize some minor points and gloss over some other major points if their program is weak. Take advantage of the time with residents to ask them how happy they are, how they get along, how they cooperate with each other, how they like the program, what are the highlights and drawbacks of it, etc. Ask the attendings about teaching and how the program trains a good pathologist. There is a nice example of good questions at:
http://forums.studentdoctor.net/showthread.php?t=71726

Are there offers outside the match?
They still do occur. Every year it seems as though they are supposed to be eliminated, but every year they still occur. Generally they are not an option for a standard US allopathic graduate. But if you are a combined degree, have already graduated med school, are an IMG, it is possible. Some programs do not offer spots outside the match, and the numbers who do this may increase as more competitive applicants enter the field. If you are good enough for them to offer you a spot outside the match, you will generally be competitive enough to match there. So don't settle, unless you want to.
 
Random Q's

What is a post-sophomore fellowship (PSF)?
It is an extension of your med school career. You take a year off between 2nd and 3rd year (or between other years if you like) to do pathology. These PSFs exist at many programs around the country, but not every program has them and they are of various qualities. They vary from where you act at a resident level (grossing specimens, doing autopsies, reviewing slides, even taking call) to basically being a glorified observer. Important to ask when applying depending on your desired result. PSFs can make your residency candidacy more competitive, but this is often not necessary. Don't do it just because you want to match in pathology, unless you have a specific reason (long ongoing research project, not sure about path as a career, etc).
http://forums.studentdoctor.net/showthread.php?t=82522
Good review here: http://forums.studentdoctor.net/showthread.php?t=111961

I am not yet in med school and interested in path!
Read this: http://forums.studentdoctor.net/showthread.php?t=83773

Work hours
Generally better than most residencies, but don't expect a 9-5 job all the time. Yes, if you are on call you generally do it from home with a phone, but sometimes have to come in for frozens or blood bank or hemepath issues. Good pathologists and motivated residents will work hard and work long hours, although probably not to the level of surgeons or most other fields. Schedules are more flexible. Path requires a lot of outside reading and study.
http://forums.studentdoctor.net/showthread.php?t=93204
Call issues: http://forums.studentdoctor.net/showthread.php?t=94638

Do DOs match into path?
All the time. DO students interview every year at most of the top programs. It's mostly about your application/resume, not about the letters after your name. All things being equal, it probably is more helpful to have MD after your name than DO, but all things are very rarely equal.

Why do you guys get off topic so much?
Dunno. Because we can! Pathology is a fun field. Try it out. The people are the best part.
 
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Thus are my FAQs and possible answers. Note that these are just my opinion, and sometimes the opinions of others linked in threads.

If you have other ideas, disagreements, clarification issues, or just want to tell me I am full of crap, let me know. I closed this thread so we can leave it just as is, as much as I like getting off topic it isn't always appropriate.

Hopefully new visitors will read this, otherwise I just wasted an hour (yup, that's all it took, believe it or not).
 
Thanks to deschutes for suggesting this one - path books info:

Surg path dissecting guides
Lester – has checklists, sample dictations
Westra-Hruban – diagrams sample sections

Some residents prefer Lester because it is more detailed in describing proper gross examination and description, and has a lot of other ancillary info related to dissecting aids, techniques, strategies, etc. Westra has good pictures and what sections are useful. There is also a grossing guide in the back of the Rosai book which is not as detailed and not as helpful for beginners.


Histology
Wheater's (histo) and (histopath) Basic, describes some things you might not get good descriptions of in standard surg path texts.
Milikowski I haven't read this one but some say it is a good alternative or improvement on Wheater for basic histopath images.
Histology for Pathologists by Sternberg This is the most detailed histo book you can find, but very dense reading. Useful as a reference though. Many people recommend every path resident should have this or at least have access to it.

Surgical Pathology texts
Rosai/Ackerman My favorite surg path text - easy to read, aimed at both novices and pros, lots of great images. Great reference for learning about diseases you are studying.
Sternberg Probably the most used surg path text in the context of daily business. More concise than Rosai, every chapter has a different author as well.
Weidner's Modern Surgical Pathology Another surg path reference, also concise, two volume set with nice organization.
Fletcher's Diagnostic Histopathology of Tumors This is probably not only one of the most beautiful and well put together books out there, but is a fantastic resource including all aspects of tumor diagnosis. Obviously though, it is all tumors and doesn't include a lot of entities. 2000 edition, may be a new one coming out soon.
Enzinger and Weiss Detailed reference of Soft Tissue pathology.
Robbins Standard med school text everyone knows about, still useful in residency for many things.
DDx in Surg Path by Haber A popular reference.
Foundations in Diagnostic Pathology System based reviews in individual textbooks.

Cytology
Practical Principles of Cytopathology aka Baby DeMay
Bethesda cytology Reference on a consistently changing topic...
Cytopathology Review Guide, 2nd Edition (Hardcover)
Koss' Diagnostic Cytology And Its Histopathologic Bases 2 vol. set

CP:
Practical Guide to Txn Med by Petrides (AABB press) Good basic blood bank reference, and readable.
McClatchey Good overall clinical path reference, easily readable.
Henry The "other" standard clin path reference - much more detailed but dense. More of a definitive reference.
Henry for call issues Good resource for call issues, as is
Clinical Laboratory Pearls by Steve Jones
Kjeldsberg's Practical Diagnosis of Hematologic Disorders
Compendium of Clinical Pathology Good boards resource.

Outlines in Pathology by Sinard - Can be accessed online (shareware) via http://www.yalepath.org/residency/OIP.htm

Forensics
Pathology of Homicide by Lester Adelson
Medicolegal Investigation of Death by Spitz and Fisher
Guide to Forensic Pathology by Dix and Calaluce
Forensic Pathology by DiMaio and DiMaio

Others
WHO books- particularly the soft tissue and hemepath books. Hemepath especially is the standard reference for diagnosis now.
Cells Tissues and Disease - conversational general path text on the history of pathology and microscopy. Great read, new edition is coming out very shortly.
Weedon Great dermpath reference for all you gunners.

Note: I am not attempting to endorse Amazon.com as your purveyor of all books, it is merely an easy way to link to the book.

Link to thread on Recommended Board Review/Question Books
 
Step 3 In A Pathology Residency: A Guide For The Perplexed

From the original by sohsie

Start thinking about USMLE Step 3 NOW! You will not be better prepared to take Step 3 than you are right now. Trust yourself, you are prepared. The longer you put it off, the more you will forget and the tougher it will be. I transferred from a program in New York where you do not have to take Step 3 as long as you are a resident or fellow. I have seen a brilliant resident (smarter than me) fail Step 3 because he blew it off until 4th year and had to blow another $600 to retake it. DONT BE THAT GUY/GIRL!

I took Step 3 in October of my first year and passed with plenty of room to spare, and believe me, it is a huge weight off my shoulders.

So what do you need to do?

1) Graduate and get your actual diploma.

2) Apply via www.fsmb.org. Don't worry about your particular state's requirements. Just apply to Connecticut (or any other state with no extra requirements). All they require is a diploma, and they dont care where you are doing your residency.

You dont have to take the exam in Connecticut. You can take the exam at any Prometric testing center in the US. I was in a training program in New York (a state that requires one year of post graduate training, which I did not have), applied to Connecticut, and then took the exam on vacation in California. Once you pass, you pass, and it counts everywhere. Is it a rational system? No. But who cares?

**Editorial interjection: Step 3 is independent of state licensure.
From the FSMB website: "Decisions regarding acceptance of USMLE results and licensure eligibility are made by the individual licensing authority. Eligibility to sit for USMLE Step 3 does NOT automatically signify eligibility for licensure."**


Be warned that it may take 6 weeks to get your entry pass to sign up for the exam, and once you get it, you have 3 months from that date to take the exam. I have heard that it now takes 2-3 weeks, but I dont know this for a fact.However, if you can't take it in that 3 month window, you can pay $100 for an extra 3 months (I had to do this)

--
Study resources cited in the past
CCS sample cases from the USMLE
Kaplan QBank/QBook
Crush Step 3
Boards and Wards
Step 3 made ridiculously easy
NMS Step 3 question book
Strong Medicine for Step 3
Blueprints Guide to the CCS
Step 3 Recall
Swanson's Family Medicine
St. Frances Guide to Inpatient Medicine - has some nice algorithms for treating certain conditions that were quite useful
Washington Manual

Step 3 day (from the Kaplan Qbook excerpt on Amazon, Nov 2004)

Day 1: 7 blocks of 48 items each.
Day 2: 6 blocks of 24 items each, followed by 9 CCS cases.

Compiled from:
Now that you've matched, it's time to pass Step 3!
Path residents who have taken Step III?
Step 3
How to study for Step 3 - from the SDN USMLE forum

- compiled by deschutes.
 
LADoc00's suggested books - if you are interested (some are the same as above books)

My last day at this job and I needed to spend $2500 on books or lose my educational fund. With roughly 90 minutes to do it too, yes I proscrastinate. I did compile what I consider the must have library for private prac of general surgical path and was able to get it for roughly that price, not bad.
They are:
Diagnostic Gynecologic And Obstetric Pathology (Hardcover)
by Christopher P. Crum, Kenneth R., M.d. Lee

Diagnosis of Endometrial Biopsies and Curettings: A Practical Approach (Hardcover)
by Michael Mazur, Robert J. Kurman


The Bethesda System for Reporting Cervical Cytology : Definitions, Criteria, and Explanatory Notes (Paperback)

Pathology And Genetics of Tumours of the Soft Tissues And Bones (World Health Organization Classification of Tumours S.) (Paperback)
World Health Organization: Tumours of the Breast and Female Genital Organs (IARC/World Health Organization Classification of Tumours) (Paperback)
by Tavassoli
WHO Classification of Tumours: Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs (World Health Organization Classification of Tumours) (Paperback)
Pathology and Genetics of Haemo (World Health Organization Classification of Tumours S.) (Paperback)

Flow Cytometry in Hematopathology: A Visual Approach to Data Analysis and Interpretation (Hardcover)
by Doyen T. Nguyen, Lawrence W. Diamond, Raul C. Braylan

Bone Marrow Pathology (Hardcover)
by Kathryn Foucar

Ioachim's Lymph Node Pathology (Hardcover)
by Harry L. Ioachim, Howard Ratech

Surgical Pathology of the GI Tract, Liver, Biliary Tract, and Pancreas (Hardcover)
by Robert Odze, John Goldblum, James Crawford

Pathology of the Skin w/CD-ROMs and with Clinical Corrections 2-vol set (Hardcover)
by Phillip H., M.D. McKee, Eduardo, M.D. Calonje, Scott R., M.D. Granter

Rosen's Breast Pathology (Hardcover)
by Paul Peter Rosen

Breast Pathology: Diagnosis by Needle Core Biopsy (Hardcover)
by Paul Peter Rosen, D. David Dershaw, Laura Liberman "

Rosai and Ackerman's Surgical Pathology 2 Volume Set (Hardcover)
by Juan Rosai

Koss' Diagnostic Cytology And Its Histopathologic Bases 2 vol. set (Hardcover)
by Leopold G. Koss (Editor), Myron R. Melamed (Editor) -OR-
The Art & Science of Cytopathology (2 volume set) (Hardcover)
by Richard M. Demay

Essentials Of Anatomic Pathology (Paperback)
by Liang Cheng (Editor), David G. Bostwick (Editor)*

Cytopathology Review Guide, 2nd Edition (Hardcover)
by E. Blair Holladay*

AJCC Cancer Staging Manual (6th Edition) (Paperback)
by Frederick L. Greene (Editor), David L. Page (Editor), Irvin D. Fleming (Editor), April Fritz (Editor), Charles M. Balch (Editor), Daniel G. Haller (Editor), Monica Morrow (Editor) **

*Very nice for boards prep.
**Often overlooked yet indispensible tome
 
Path Residencies and the IMG:

I'm an IMG - what are my chances of matching into pathology?
From the perspective of IMG applicants, there are in general 3 levels of residency programs:

First level: Waaaay up there. These places are looking for scores in the 90's and research experience etc. And yes you will likely find that they prefer AMGs (e.g. 99% of current and past residents are AMGs) and this trend is not likely to change. There are exceptions of course. Apply early if you want one of these places.

The next level - and this is the majority: Score cut-offs of ~85, with a mixture of both AMGs and IMGs in these programs. Good programs, and well worth the effort. If you're not an absolute star I'd focus on these.

The last level: Really no cut-off at all as long as you passed your exams - these are programs on probation or in underserved areas/in the middle of nowhere or just for whatever reason fall in the category of "not that great", and these take both IMG and AMG, just anyone who'll go.

So there's something for everyone.

When applying, do like you would do when applying for any job - research the place you have in mind. Look at the websites of programs, residents' profiles, attendings' profiles, talk to someone there if you can, ask the secretary what their cutoff scores are and if you are the type of applicant they would look at, and... ask for an interview!

-- hzma/deschutes
 
Path Board Exam Logistics

Highlights from both the CAP residents' forum and the USCAP housestaff specialty conference -

ABP Exec Vice-President Dr. Betsy Bennett:

Pre-Boards:

The Booklet of Info on abpath.org should be required reading.
You need to have your full and unrestricted state medical license before you take the exam or your results will not be released.
Timeline of training: "months" vs. "rotations" – 4 weeks/month + 4 weeks vacation = 13 months in the ABP year.
In the case of any adverse action – PD and applicant need to be on the same page (i.e. you need to clarify with your PD if a specific incident in residency really was an adverse action)
Of the 50 required autopsies, there is no limit by ABP on #s of forensics/limited/shared autopsies, i.e. "Just get 50" - the limit is purely clinical.

Application Deadlines:
Spring Exam – Jan 15
Subspecialty – May 1
Fall exam – May 1 (Aug 15 for repeaters)
Single certification – Apr/Oct 1

Fees:
$2200 AP/CP in one sitting
$1800 single sitting or retake of one failed portion
(ABP is looking at lowering the retake fee, but don't hold your breathe for it to happen this year)

Exam day:
Exam dates generally between June 1 and July 10, dates assigned in early March
ABP realizes that this is often in conflict with moves for fellowship/jobs, but for the time being this cannot be helped.
The exam day ends 4:30 - 5pm.
Preferred airport is Tampa International (3 miles, $10 taxi one way).

The Wyndham Westhore is the recommended hotel, with complimentary airport shuttle q30mins. Past examiness recommend asking for a room in the back of the hotel, since there is a 6-lane highway in front. ABP rate is $127/night.
2nd favourite was the Best Western Westshore which is less expensive.

Criticism of Exam content
ABP is aware of disparity between boards Qs and real life

5-6 people on the exam review board, serving 5-year terms
Most are academics – community pathologists are highly sought after, but not many volunteer.
Question bank: has 50k? 500k? questions
The review board gets together on a weekend to review questions – if they can find the answer on Google, it stays.

Maintenance of recertification:
10-year terms
You can start applying during 8th year, in case you need to retake.

~

Methods of Resident Feedback to the ACGME RRC:

Dr. Margaret Grimes, ACGME Pathology Residency Review Committee Chair is aware that there are disparities between reported performance and actual performance when it comes to residency programs.

She highly encouraged direct feedback from residents to the RRC via the ACGME-administered survey, conducted q3yrs.

She underscored the message that the ACGME did not intend to penalize programs or residents, but would much rather see them get their act together.

-- deschutes

Sources:
USCAP / CAP Spring '07, plus the usual personal inquiries ;)


Also check out:
yaah's Boards experience from July 2008
 
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Q: Do residents have time to do research during residency? Is research important? Can I get a fellowship without research?

A: You are unlikely to have time to do groundbreaking research during residency involving significant bench work. Many residents are able to fit in a component of bench research during their training, but it is not usually full time, and many will take elective time to do it. What most residents (if they do any) do for research is on the grounds of clinically-related projects (evaluating immunohistochemical markers, correlation studies, observational studies, case reports). This is all very possible but of course does add time to your probably already busy schedule.

Research is important for fellowships. When evaluating candidates, fellowship directors basically have your CV and your reference letters. Oftentimes, reference letters are crucially important, especially if they are from names that are familiar to the fellowship director (either former faculty, trainee, or simply a well known name and colleague). The main part of your CV that is important is your publication/presentation record. Demonstrating interest in the field of your choice by means of abstracts, presentations, and publications is important not only to show interest in the field but to show that you can follow through on projects, that you have gone into deep understanding of areas of the field of study, and that you have sufficient organizational skills and intelligence. You can learn all you want about a certain subject through reading literature or texts, but experiencing it through research is a different experience altogether. Many fellowship directors want to see this commitment. Otherwise, you may be a capable and qualified resident but how does that make you better than another candidate?

It is difficult to get a competitive fellowship without doing some kind of research or projects. If you have an "in" to a certain program (it's your home program, you know the fellowship director well, etc), you can do less (maybe!), but programs are unlikely to bend over backwards to accomodate you.

Linking here to a good thread on research in residency and academics, advice, etc.
 
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