attendings and resident training

sleeping beauty · Jul 29, 2007

I need some kind opinions from senior fellow residents.

I am in one of the smallest programs in the world, if not THE smallest. we have only 4 X 0.5 =2 attendings. let's say attendings A, B, C, D.

Mean age of attendings C and D close to 80 yo (I mean EIGHTY). Both of them are dedicated teachers and good teachers. that's probably one reason they are still here. C mainly teaches high school students, undergraduates, and medical students. D teaches residents by a way of lecture. Neither of them seem to actively involve in any sign out with residents.

both attendings A and B sign out. however, the problem is that neither of them is interested in teaching, NOT AT ALL. they are reluctant to work with student fellows or new residents; During sign-out, everyone keeps mouth wide shut.... There are not many communications/interactions between attendings and residents. There seems more anger than anything else and than anywhere else between senior residents and attendings. For student fellows and new residents like me, the only way to learn is from senior residents.

My questions for fellow seniors are: how deeply do the attendings in your programs involve in teaching? how can I improve my diagnostic skills since we have such limited resources?

deschutes · Jul 29, 2007

Wow. Those are hard questions. I had not known such places existed. And are accredited by the ACGME!

I'd think that the best way would literally be out - can you transfer somewhere else? It's not merely a question of diagnostic skills/pathology knowledge base, but also the competency of trainees graduating from such a program practising independently, and their employment outlook in the future.

All kinds of questions jump to mind:
- what is the boards pass rate for your trainees?
- does your program director/GME department know of these issues?

Thaitanium · Jul 29, 2007

sleeping beauty said:
I need some kind opinions from senior fellow residents.

I am in one of the smallest programs in the world, if not THE smallest. we have only 4 X 0.5 =2 attendings. let's say attendings A, B, C, D.

Mean age of attendings C and D>80 yo (I mean EIGHTY). Both of them are dedicated teachers and good teachers. that's probably one reason they are still here. C mainly teaches high school students, undergraduates, and medical students. D teaches residents by a way of lecture. Neither of them seem to involve in any sign out.

both attendings A and B sign out. however, the problem is that neither of them is interested in teaching, NOT AT ALL. they are reluctant to work with student fellows or new residents; During sign-out, everyone keeps mouth wide shut.... There are not many communications/interactions between attendings and residents. There seems more anger than anything else and than anywhere else between senior residents and attendings. For student fellows and new residents like me, the only way to learn is from senior residents.

My questions for fellow seniors are: how deeply do the attendings in your programs involve in teaching? how can I improve my diagnostic skills since we have such limited resources?

That seriously sucks. I feel for you. Can you transfer out? I don't know how these programs receive accreditation. If you are going to be a pathologist, you cannot afford to have weaknesses. You are going to be diagnosing diseases for crying out loud.

schrute · Jul 29, 2007

Not that you want to advertise what program you're in, but any suggestions on a particular state you recommend not applyin to? ...or a part of the country with a particular state flower or agricultural product ...

mlw03 · Jul 30, 2007

if there's only 4 attendings, and 2 are really old and don't sign out and 2 are younger and don't teach, i'm wondering who's the program director? seriously, how can a pathology residency only have 4 faculty members?

LADoc00 · Jul 30, 2007

sleeping beauty said:
I need some kind opinions from senior fellow residents.

I am in one of the smallest programs in the world, if not THE smallest. we have only 4 X 0.5 =2 attendings. let's say attendings A, B, C, D.

Mean age of attendings C and D>80 yo (I mean EIGHTY). Both of them are dedicated teachers and good teachers. that's probably one reason they are still here. C mainly teaches high school students, undergraduates, and medical students. D teaches residents by a way of lecture. Neither of them seem to involve in any sign out.

both attendings A and B sign out. however, the problem is that neither of them is interested in teaching, NOT AT ALL. they are reluctant to work with student fellows or new residents; During sign-out, everyone keeps mouth wide shut.... There are not many communications/interactions between attendings and residents. There seems more anger than anything else and than anywhere else between senior residents and attendings. For student fellows and new residents like me, the only way to learn is from senior residents.

My questions for fellow seniors are: how deeply do the attendings in your programs involve in teaching? how can I improve my diagnostic skills since we have such limited resources?

Im going to need some clarification...are you at a VA hospital or something???

I have never heard of such a set up...never...not in the US.

BUT the situation is far from lost. I have a number of suggestions.
1.) go to as many conference as possible. With a department so small, they wont miss you for a 1-2 months/year.
2.) Do away rotations at huge mill places like MDA or MSKCC.
3.) Prepare to have to do a surg path fellowship. Shop it around. Look for low key places (as in not Stanford, BWH, MGH, JHU etc) where you can get references from.

References are your biggest problem considering 2 of your staff are likely voluntary emeritus faculty and may very well be DEAD by the time you are looking for a job. Also realize you need 3-4 references to even sit for the boards!!!

I want more info...where are you? Alaska? A military base somewhere near the Philippines?......tell us, Im very curious.

PS- thought a bit more about this..it has to be offshore somewhere or some type of military set up.

sohsie · Jul 30, 2007

LADoc00 said:
Im going to need some clarification...are you at a VA hospital or something???

I have never heard of such a set up...never...not in the US.

BUT the situation is far from lost. I have a number of suggestions.
1.) go to as many conference as possible. With a department so small, they wont miss you for a 1-2 months/year.
2.) Do away rotations at huge mill places like MDA or MSKCC.
3.) Prepare to have to do a surg path fellowship. Shop it around. Look for low key places (as in not Stanford, BWH, MGH, JHU etc) where you can get references from.

References are your biggest problem considering 2 of your staff are likely voluntary emeritus faculty and may very well be DEAD by the time you are looking for a job. Also realize you need 3-4 references to even sit for the boards!!!

I want more info...where are you? Alaska? A military base somewhere near the Philippines?......tell us, Im very curious.

PS- thought a bit more about this..it has to be offshore somewhere or some type of military set up.

If I remember correctly (jsut took the boards in June), you just need two references, and one of them must be your program director.

sleeping beauty · Jul 30, 2007

it is a university program. GME department is in the same boat as the program and they know better than we residents do. they also want to survive.

yes. i went to all conferences. i went to all sign-outs.

LADoc00 · Jul 31, 2007

sleeping beauty said:
thank you all for your replies. i should have provided you guys more information.

1.it is a university program. since there are only 4 attendings, either the chair/PD is one of them or there is no chair/PD. one of the attendings was retired when most of you guys were still a baby.

2.yes. i went to all conferences. i went to all sign-outs. but as i said, everyone keeps mouth "wide shut" during signout. what we new people are happy about is we have two senior residents who are very willing to teach us.

3. because of competition from other hospitals, there are significant physician turnover. this leads to the dramatic drop of our autopsy number and surgical specimen. as of today this, they are in mid 20 and mid 4k respectively. GME department is in the same boat as the program and they know better than we residents do. they also want to survive.

4. their physician number in FREIDA is over 30 and over 40 on their departmental web.

5. I have no problem with anyone in the program and I like all of them. no single attending was mad at any new people. actually after one attending was mad at a senior resident, i gave the attending a canday, he/she started to laugh. the gap is that I want more attendings who are willing to teach.

i have some more practical questions:
1, is it possible for me to join 2008 match as PGY1?
2, should i quit now to join 2008 match as PGY1 or keep current PGY1 to join 2008? (I have one thousand reasons not to honor my contract)
Transfer as a PGY2 is not easy. I am willing to start as a PGY1 again.

WTF. Are you saying there is a residency program at a university somewhere in the US with 4 attendings, a gaggle of residents and ACGME accred. doing LESS surgical volume than me, myself and I? That is like 30-40 cases a day. What do you possibly do the other 7 hours 45 minutes of the day??
That actually kinda sounds like a killer program. You must read a metric TON of books. You could read every path. book ever written in year 1 and spend years 2-4 playing World of Warcraft/Everquest/Age of Conan 40 hours/week....hell you could show up the first day of residency, then leave, come back year 4 graduate and get a job running a CP lab somewhere..

Wow, I should form a residency program....hmmmmm

deschutes · Jul 31, 2007

sleeping beauty said:
it is a university program. GME department is in the same boat as the program and they know better than we residents do. they also want to survive.

yes. i went to all conferences. i went to all sign-outs.

LADoc00 is referring to regional (state association of pathologists meet) and national conferences like USCAP, ASC, ASCP, CAP etc. Those have educational courses that you can take.

You could also go to the ASCP review, or the Osler course.

sleeping beauty · Aug 4, 2007

"regional (state association of pathologists meet) and national conferences like USCAP, ASC, ASCP, CAP etc."

but we have only $600 for conference and books. we need to buy some books. no single book is cheap.

deschutes · Aug 5, 2007

If you have no faculty and no resources, it is seriously time to consider communicating with the ACGME. Residents cannot teach themselves pathology. Would you want your biopsy read by a graduate of your program?

http://www.acgme.org/acWebsite/navPages/nav_residents.asp

sleeping beauty · Aug 5, 2007

thanks. communicating with the ACGME is probably not the best approach for me.

(I made a mistake : autopsy number is in mid 40. surgical specimen is still in 4k)

yaah · Aug 6, 2007

Well, at some point you are going to have to be proactive. It is your education and your future. You do not exist solely to serve their needs for a warm body and to bring in funding. Their job is to teach you. If they can't do that, it is NOT your fault. People are not going to come to you with solutions, other programs aren't just going to offer you positions sight unseen. You are in a tough situation which requires your own action, unfortunately.

sleeping beauty · Aug 22, 2007

our residents reported our situation to our medical school dean. he wants to survive. naturally, nothing happened.

just knew that our residents did report our program to ACGME a while ago. it took one year for ACGME to respond. other than a response, no site visit. nothing has changed.

is ACGME really useful?

path19 · Aug 22, 2007

my $ is on eastern virginia medical school. anyone else?

p.s. everyone is right, you have to take matters into your own hands, you CANNOT count on anyone else to look out for your best interests because they won't. so you have a choice to make: 1) stay put and study, study, study (including buying study sets of slides, etc to make up for real cases), go to as many conferences as possible, and try to get some away rotations if you can (preferably at high volume places with reputations for good teaching, or 2) decide to transfer and pour every ounce into finding a place that will accept you for the rest of your training. option #2 will be awkward for sure, but this is your 1 and only chance to learn to be a pathologist, so do not waste it. and although reporting to acgme is a good idea, you cannot afford to wait until they take action.

mlw03 · Aug 22, 2007

path19 said:
my $ is on eastern virginia medical school. anyone else?

i dunno where this poster is referring to, but i wish i did. obviously it's some pretty small place. could be a community program too. but if i interview somewhere where i can count the total number of residents on one hand, i'd take it as a red flag no matter what.

agree with the comments that this poster's best move would be to try and transfer.

yaah · Aug 23, 2007

sleeping beauty said:
just knew that our residents did report our program to ACGME a while ago. it took one year for ACGME to respond. other than a response, no site visit. nothing has changed.

is ACGME really useful?

I don't buy this.

The ACGME visits every program. They have to. They send senior pathologists out, they interview residents independently, they ask lots of tough questions, etc. It is not a softball situation.

I'm beginning to wonder if your program is actually accredited. If it's as bad as you say it is, you need to do more than sending a couple of complaining emails to GME, ACGME, etc.

sleeping beauty · Aug 23, 2007

I swear to God I did not lie. I had the opportunity to attend an internal review meeting today. senior residents reported that we had not had a formal surgical path lecture for 1.5 years.........

yaah said:
I don't buy this.

The ACGME visits every program. They have to. They send senior pathologists out, they interview residents independently, they ask lots of tough questions, etc. It is not a softball situation.

I'm beginning to wonder if your program is actually accredited. If it's as bad as you say it is, you need to do more than sending a couple of complaining emails to GME, ACGME, etc.

pathnerd · Sep 22, 2007

Sleeping Beauty,

I understand if you would prefer not to say, but are you by chance a resident in one of the post-Katrina New Orleans residency programs?

sleeping beauty · Sep 22, 2007

I strongly believe that any programs, including any community programs and any New Orlean programs, have better education.

It is not East Virgina. It is in North and in east time zone.

it seems that our program knew this thread shortly after I started it. I appreciate everyone's support. I appreciate even more if you do not move this thread again to the front page.

any question will be answered if you send me an message with official email address.

This thread is closed.

PathJet · Sep 22, 2007

um ok so like if your name is sleeping beauty like how would they know about the thread? how would they know posted the thread? is your name sleeping beauty in real life?

i thought they were mean an uninterested in residents? so you are saying they also cruise SDN for people who post bad things about them?

how many residents are in the program?

\ your program is also supposed to have an anonymous evaluation set up so the residents can safely evaluate your attendings-not only that but there is a yearly acgme evaluation you are supposed to complete

what about your other residents are they cool with everything?

sleeping beauty · Sep 22, 2007

we do evaluate 2 surgpath faculty. faculty A can read the evaluation and faculty B cannot. therefore the evaluation is one-sided.

other residents? one reported to ACGME. several met dean.

we have very few residents. they know i am obssessed with online forums.

pathstudent · Sep 23, 2007

Are you at the university of south dakota.

i remember seeing they only had 4 residents back in my ERAS days.

djmd · Sep 23, 2007

Look people the original poster asked to close this discussion, and not discuss this further in here, yet everyone continues to do so....

Let's honor that request.

Yaah, can you lock this thread?

pathstudent · Sep 23, 2007

Alternately the O.P. could just quit responding.

deschutes · Sep 24, 2007

Thread closed by request. And yes, not responding is always an option.

P.S. If you use the "Report Post" function, a message will get to one of us mods faster.

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