Advice for incoming residents

[tig3r]

Do you guys have any advice for incoming pathology residents? Common mistakes you've seen first years (or other years) make? Tips to make the next four years run more smoothly? Anything you wish you had done differently looking back on your own experience? Thank you for your time.

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[Gene_]

Show up and be on time. Don't make a habit of leaving early. Be prepared.

 

[listeriaismfb]

I was not prepared for some of the cut-throat gunner tactics I saw, I mean who cheats and looks up the cases for unknown conferences & hemepath conferences?!

Hope for the best in people, but be prepared for the worst.

 

[sohsie]

Do you guys have any advice for incoming pathology residents? Common mistakes you've seen first years (or other years) make? Tips to make the next four years run more smoothly? Anything you wish you had done differently looking back on your own experience? Thank you for your time.

Speak up in unknown conferences. Say what you think it is. Don't worry about being wrong. You will learn a lot more this way.

 

[MirkoCrocop]

Create a skintight seal between the microscope and your eyes for better visualization and quicker diagnoses.

 

[yaah]

Speak up in unknown conferences. Say what you think it is. Don't worry about being wrong. You will learn a lot more this way.

+1

Don't worry about being wrong. Ask questions. Don't assume you know everything, and don't assume that "getting the right answer" is the only important thing. This isn't just for conferences, but for signout, whatever.

 

[KeratinPearls]

+1

Don't worry about being wrong. Ask questions. Don't assume you know everything, and don't assume that "getting the right answer" is the only important thing. This isn't just for conferences, but for signout, whatever.

yeah i tend to learn a lot from signout. even more when the person you signout likes to teach. yeah i tend to remember a lot more when asking questions at signout.

 

[Cloaca]

Yeah, I have found over the past three years that the more idiotic an answer I blurt out, the more likely I am to remember the correct answer the next time (and actually go read about the topic). And honestly, everyone says stupid stuff all the time because we are learning. Fortunately, my frequency of foolish answers has decreased! So go for it!

 

[Cloaca]

My piece of advice, as a chief and senior resident, is that from Day 1 you should realize that you are part of a team and that what you do (or don't do) affects others. Every day there will be times when you want to be lazy and leave little things for other people to do, but you have to realize that your colleagues will notice that you are lazy and care more about your time than everyone else's. And then they are less likely to help you out when you need it, and trust me, you will need help from time to time. Also, attendings notice.

 

[HbyHA]

My piece of advice, as a chief and senior resident, is that from Day 1 you should realize that you are part of a team and that what you do (or don't do) affects others. Every day there will be times when you want to be lazy and leave little things for other people to do, but you have to realize that your colleagues will notice that you are lazy and care more about your time than everyone else's. And then they are less likely to help you out when you need it, and trust me, you will need help from time to time. Also, attendings notice.

also as a chief and a senior resident, and building on the excellent advice given by Cloaca...

be the kind of resident that YOU'D like to work with. help others out, even if they can't immediately pay you back. learn when to say "enough" in regards to tasks, ie taking on extra projects and such. try to have BALANCE in your life. you need to do something each week for YOU, be it going to the gym, spending time with friends or family, whatever. you're going to have times when you feel stressed out and overwhelmed, but it WILL get better. you will feel especially dumb as a first year, but you will learn so much that you'll surprise yourself by the end of the year. try to laugh as much as you can.

Good Luck.

 

[pathstudent]

Do you guys have any advice for incoming pathology residents? Common mistakes you've seen first years (or other years) make? Tips to make the next four years run more smoothly? Anything you wish you had done differently looking back on your own experience? Thank you for your time.

Try to get a research study going right a way. You don't have to necessarily know anything about the subject, but you do have to be willing to be organized, to not be lazy, to read literature and to write. Try to get some initial data to apply to USCAP by the September deadline even if the research is not complete. Being a first year at USCAP will make you stand out in your program.

Talk to a subspecialized faculty in an area that you think may be interested in but balance that with the reputation of the faculty and his track record of getting publications completed with residents. Talk to your seniors to find out who are the best people to work with.

 

[2121115]

1) Don't be scared about being wrong. Be wrong boldly. Ask questions. Have no pride when it comes to this because if you get to second year and don't know certain things you will look like an idiot.

2) It sounds cheesy, but be a "team player".

3) Don't kiss ass. People notice if you are always kissing ass and they remember.

4) Drink a lot of beer and get your colleagues out drinking with you. Seriously.

 

[Gyric]

1. Do more than your share of the work, don't complain, and always do what is best for your patient.
2. Choose a fellowship early.

 

[bioguy]

4) Drink a lot of beer and get your colleagues out drinking with you. Seriously.

thats the advice i was looking for. will definitely follow it.

 

[HbyHA]

4) Drink a lot of beer and get your colleagues out drinking with you. Seriously.

How silly of me to have left that off my list!

 

[pathstudent]

Try to get a research study going right a way. You don't have to necessarily know anything about the subject, but you do have to be willing to be organized, to not be lazy, to read literature and to write. Try to get some initial data to apply to USCAP by the September deadline even if the research is not complete. Being a first year at USCAP will make you stand out in your program.

Talk to a subspecialized faculty in an area that you think may be interested in but balance that with the reputation of the faculty and his track record of getting publications completed with residents. Talk to your seniors to find out who are the best people to work with.

I should also say that don't bite off more than you can chew. Nothing brands you as more of a loser as agreeing to do a project or write up a case report and not coming through.

Also remember that a conference poster without a journal publication is a job left undone, so don't think it is enough to just make it to USCAP. You got to get that poster into an article and that article into a journal.

 

[dodobird13]

1) Don't be scared about being wrong. Be wrong boldly. Ask questions. Have no pride when it comes to this because if you get to second year and don't know certain things you will look like an idiot.

2) It sounds cheesy, but be a "team player".

3) Don't kiss ass. People notice if you are always kissing ass and they remember.

4) Drink a lot of beer and get your colleagues out drinking with you. Seriously.

yeah... team player is good and all but be yourself and do what you think is the right thing to do. don't get lazy or take shortcuts just because your seniors do it. don't get sucked into groupthink.

be nice to the lab staff, including your attendings. remember that the sole purpose of their existence is not to serve you pearls of wisdom on a velvet pillow. be an active participant. don't take things personally. (although this can be the hardest in the OR with a jackass surgeon)

like others have said in so many words, leave your ego at the door. don't be afraid to look stupid or ask what you might think are silly questions, but don't ask them in a disingenuous manner just to be a kiss-ass (i.e., if it is explicitly stated in a basic pathology book, don't ask it.).

start studying early and often!

 

[Doctor Zaius]

Read 1hr/day, everyday. Everyone does this the first couple of months of residency and everyone does it again to study for boards.

The great ones study every day for all four years. It's frustrating in the beginning because it's so overwhelming, but if you keep it up, by your second year you'll pull away from the pack and people will definitely notice.

 

[ScotchBonnet]

Try to get a research study going right a way. You don't have to necessarily know anything about the subject, but you do have to be willing to be organized, to not be lazy, to read literature and to write. Try to get some initial data to apply to USCAP by the September deadline even if the research is not complete. Being a first year at USCAP will make you stand out in your program.

Talk to a subspecialized faculty in an area that you think may be interested in but balance that with the reputation of the faculty and his track record of getting publications completed with residents. Talk to your seniors to find out who are the best people to work with.

Does anybody have any second opinions on the feasability of this suggestion? As much as I want to be involved in research during residency and present at USCAP, publish, etc., I imagine the first few months will be plenty busy enough adjusting to a new city, learning to have the slightest clue as to what I am seeing under the microscope, cultivating a new social life...

 

[gbwillner]

Does anybody have any second opinions on the feasability of this suggestion? As much as I want to be involved in research during residency and present at USCAP, publish, etc., I imagine the first few months will be plenty busy enough adjusting to a new city, learning to have the slightest clue as to what I am seeing under the microscope, cultivating a new social life...

Yeah, good point. This is really program specific. 1st year residents at USCAP are extremely rare. Programs that are high volume make this exceptionally difficult.

 

[yaah]

Yeah, good point. This is really program specific. 1st year residents at USCAP are extremely rare. Programs that are high volume make this exceptionally difficult.

That's mostly because the abstract deadline is in september, giving you only 2 months to get anything together. First years that go to USCAP usually are presenting a project they did during med school.

I would suspect most people would not recommend you immerse yourself in new clinical projects immediately after starting residency. Give yourself a couple of months and rotations, see what faculty you might get along with, maybe join up with a senior resident to help out on a project they are also involved with. I think a good time to start getting involved with projects is the second half of your first year.

 

[KeratinPearls]

Does anybody have any second opinions on the feasability of this suggestion? As much as I want to be involved in research during residency and present at USCAP, publish, etc., I imagine the first few months will be plenty busy enough adjusting to a new city, learning to have the slightest clue as to what I am seeing under the microscope, cultivating a new social life...

I'm a first year and it has taken me a lot of time to learn how to gross, organize my workflow, look at slides and bring them to the attending...if you can do research on top of all this as a first year and do it well, hats off to you. You also have to master basic histo, read about the common diseases you encounter at the bench, learn the basic path you forgot during med school...

 

[ScotchBonnet]

Thanks to everyone who addressed my question. No offense to pathstudent and his/her original suggestion, but you all have confirmed my hunch that the first few months of residency will be busy enough just learning the ropes.

 

[pathstudent]

Thanks to everyone who addressed my question. No offense to pathstudent and his/her original suggestion, but you all have confirmed my hunch that the first few months of residency will be busy enough just learning the ropes.

That's fine. It depends on how motivated you are. Most people don't go to USCAP their first year, but it wouldn't be that uncommon. Still get something started early and apply at a spring deadline or sept 2010 for USCAP 2011.

 

[caffeinegirl]

I've seen a trend...that I guess may not be limited to my geographic vicinity given some of the posts here. Is it just me or does there seem to be a lot more pressure (both self-driven and I guess from outside forces) to work on academic projects early in residency (ie. first year)?? Makes me stressed out just thinking about it!!

My advice for those who are just about to begin residency is simple. Start with an open mind, and absorb as much as you can. Pay attention during sign out and during conferences. It is guaranteed that you will not be able to understand everything that is happening, but with time you will. The main goal during the first couple of months is understanding workflow and basic histology. If you don't know what's normal (ie. what a nerve a looks like) then you won't be able to find out what's abnormal (ie. perineural invasion). With repetition you'll slowly be able to recognize things the next time they show up on your scope. Depending on your program (subspecialized or not), it'll be a while before you see that specific entity again, but at least it'll be familiar the next time you see it. I didn't feel things "coming together" until about the end of my SECOND YEAR of AP (AP-only). So don't despair if you feel like you don't know anything..it takes time.

As for projects...I would recommend NOT doing projects until the end of the first year..when you've finished rotating through mostly everything and can gather an idea on what specialty you're most interested in, and after you've met and worked with most of the attendings. It's the worst if you spend tons of time and effort on a project on a topic you don't care for, and with somebody you don't get along with. It's rare to find a first year with a new publication by the end of their first year. Abstracts to CAP are easier to put together (deadline is April) rather than USCAP (deadline is September) as a first year. But having publications or going to conferences does not make you a superstar. Knowing the breadth and depth of your field makes you a great pathologist.

Take time for yourself and your family/significant others. Don't forget the outside world...it's easy to get totally sucked into work, and think about pathology 24/7 (heck, I even dreamed about it) as a first year. Find time to relax, or do things that make you feel like yourself....where you don't think or talk about pathology.

And finally, and MOST importantly..remember that your #1 goal as a pathologist is patient care. This comes first and foremost. We are physicians, and we take care of patients.

It's a wild ride, you're going to love it, and it's worth every second. Enjoy and welcome to the field.

 

[yaah]

Caffeinegirl makes good points - I think there might be more pressure. Although I think a lot of this might be self-induced, and not necessarily legitimate outside pressure from attendings. Fellowship applications happen early. If you are AP only, they start at the end of your first year. So unless you have a previous interest a lot of people think they have to get going early. Many fellowship directors understand this, and won't necessarily be looking for people who have already published works - sometimes just the interests and abstract is good.

As far as time commitment, I don't know about the rest of you but first year (particularly first half of first year) was the least time commitment of my entire residency. This anticipated free time of later years isn't really going to materialize. As you go through training you do get more efficient though and working on projects might become easier though. PLus, you have more experience and knowledge of how things work in the department (which is key for doing the gruntwork that is typical of research projects).

I would second the notion to spend more time concentrating on becoming a good pathologist. Fellowships will be looking at this as well, through your reference letters and performance.

 

[ScotchBonnet]

Caffeinegirl makes good points - I think there might be more pressure. Although I think a lot of this might be self-induced, and not necessarily legitimate outside pressure from attendings. Fellowship applications happen early. If you are AP only, they start at the end of your first year. So unless you have a previous interest a lot of people think they have to get going early. Many fellowship directors understand this, and won't necessarily be looking for people who have already published works - sometimes just the interests and abstract is good.

So it sounds like having projects in the works but still unfinished is sufficient for applying to fellowships. Are there any fellowships that are so competitive that they require completed projects (i.e. publications)...derm path maybe?

 

[Cyton]

Also remember that a conference poster without a journal publication is a job left undone, so don't think it is enough to just make it to USCAP. You got to get that poster into an article and that article into a journal.

Not sure about this one... Most of the tripe crapaducchio that adorns the walls at USCRAP should not waste any more ink,paper and or resources.

 

[yaah]

So it sounds like having projects in the works but still unfinished is sufficient for applying to fellowships. Are there any fellowships that are so competitive that they require completed projects (i.e. publications)...derm path maybe?

I'm just saying it all depends. It's a little bit unrealistic to expect some AP-only candidates to have completed published articles when applying for fellowship given that they have only been in residency for 12 months. It takes more time than that for some journals to get the article through the publication process.

 

[MirkoCrocop]

Not sure about this one... Most of the tripe crapaducchio that adorns the walls at USCRAP should not waste any more ink,paper and or resources.

agreed. i actually submitted some poster to the CAP that could be rejected, but if not, i dont think id think about getting it published

 

[caffeinegirl]

So it sounds like having projects in the works but still unfinished is sufficient for applying to fellowships. Are there any fellowships that are so competitive that they require completed projects (i.e. publications)...derm path maybe?

For dermpath and competitive fellowships, participating in projects and submitting abstracts to meetings is good. Having papers in press/under revision is great. Having published papers is stellar.

My experience, however, when all is said and done is that it's not what you've done but who you know which can help you get a fellowship (especially one not at your institution).

 

[Pingu]

My experience, however, when all is said and done is that it's not what you've done but who you know which can help you get a fellowship (especially one not at your institution).

This is the absolute truth. Also, don't burn bridges. Path is a small community and backing out of fellowships and other commitments can very quickly give you a bad reputation, even if your reasons are legitimate.

My advice:
Show up and be on time.
Don't be afraid to say "I don't know" or ask questions.
Be yourself but also understand when you need to conform.
Offer to help people with cases or grossing or conferences, but don't be a doormat.
The secretaries and techs and transcriptionists can SAVE YOUR BUTT. Know this and get to know them...sometimes experience is far more valuable than education.
Pick your battles. Know when to crusade and when to hide in a hole.
Have a life outside residency.
Use all of your vacation days...you will need time to regain your sanity.
Be upfront when you make a mistake. Apologize and then do whatever you need to correct it.

 

[LADoc00]

The social aspect of residency is HUGE. I cannot overstate this enough.

Do NOT be that guy/gal who never attends parties, never goes out for a night to have dinner and hides in the shadows studying slide sets.

Residency is not your undergrad O-chem class, you need recommendations, connections and favorable personal opinions to land jobs.

You dont have to be at a disadvantage being Muslim, Mormon or Adventist. You dont have to be excluded because you have 3 rugrats and a 19-year old wife at home. Make the effort, that is the important part. Even if it is going out for a movie and a burger (or veggie burger or whatever you hippies eat). Its not an all-or-nothing situation.

 

[Pathwrath]

The social aspect of residency is HUGE. I cannot overstate this enough.

Do NOT be that guy/gal who never attends parties, never goes out for a night to have dinner and hides in the shadows studying slide sets.

Residency is not your undergrad O-chem class, you need recommendations, connections and favorable personal opinions to land jobs.

You dont have to be at a disadvantage being Muslim, Mormon or Adventist. You dont have to be excluded because you have 3 rugrats and a 19-year old wife at home. Make the effort, that is the important part. Even if it is going out for a movie and a burger (or veggie burger or whatever you hippies eat). Its not an all-or-nothing situation.

I second all this and would also add:

Don't be an as$hole.

Pathology, despite what cheery CAP and residency directors may tell you, is a small and declining field. Stories circulate rapidly and widely. A few choice words from a peer who remembers your bad behavior may sink an opportunity even years later.

 

[deschutes]

I keep trying to come up with responses that are original, but by the time I logon I have usually forgotten them.

Here's one for today:
If you can't do the 1 hour/day, do 5-10 mins/day. Pick up a book and look at the pictures/captions instead of wading through the text.

Rinse, repeat.

About the burning of bridges - I have seen them mended.

 

[JPmamd09]

Bump. Anyone finishing up first year have anything to add?

I need something else to read on here - I can't handle anymore healthcare debates/debacle threads or I'll puke.

 

[Perry Mason]

A few practical aspects from a first-year.

1. Read Lester before you start in July.

2. Get hands on as soon as poss. Don't wait until the end of your orientation month/week/whatever to start grossing.

3. Don't be afraid to pick complex specimens. Whipples, pelvic exenterations and neck dissections are a piece of cake once you know how to deal with them. Again, read Lester.

4. Learn how to dictate good gross descriptions. Be systematic, detailed and to the point. Attendings appreciate it, transcriptionists appreciate it, the residents who you help out grossing appreciate it.

Good luck

 

[Perry Mason]

.....

 

[multiplemyeloma]

Which book is 'Lester'? Does it describe grossing techniques? Does anyone have a used version they want to sell?

 

[TinyFish]

Is it this? http://www.amazon.com/Manual-Surgical-Pathology-Carole-Lester/dp/0443079188

Does anyone else recommend it? Are there any other text recommendations?

 

[2121115]

My advice for incoming residents?

1. Don't read this board.

2. Don't take out any loans in medical school.

 

[yaah]

Is it this? http://www.amazon.com/Manual-Surgical-Pathology-Carole-Lester/dp/0443079188

Does anyone else recommend it? Are there any other text recommendations?

That's a great book to learn how to gross - the first few chapters are also helpful in explaining common techniques and procedures.

There is another book by Westra http://www.amazon.com/Surgical-Path...ed-Guide/dp/0387955593/ref=dp_cp_ob_b_title_1 which is a little heavier on the images, and some people prefer it from a visual perspective. I liked how the explained certain specimens, but overall preferred Lester.

 

[Euchromatin]

My advice for incoming residents?

1. Don't read this board.

2. Don't take out any loans in medical school.

ROFLMAO...I had enough scholarships and part time work to get through undergrad without taking out student loans, but with the exception of a very few classmates whose parents were loaded, everyone that I know had to take out loans in medical school.

Any other suggestions for what to study before residency starts besides the Lester? Robbins? Review all my histo notes? Or just enjoy the last few weeks of freedom?

 

[Sulfinator]

. . . enjoy the last few weeks of freedom

I'm going to predict that the above is the answer you're going to get from most people.

 

[Perry Mason]

I'm going to predict that the above is the answer you're going to get from most people.

Indeed.

Forget about Robbins. It was good enough for medical school. The general path part is good and you might want to read it before the boards, in four years time. As for systemic pathology, as a general text it's either Sternberg or Rosai, I personally prefer the former. They are not very detailed either and need to be supplemented as required.

Having said all that, there is little point reading any of the above before residency.

Lester is an easy read, you can flip through it in two nights just to get a general idea. I mean, don't attempt to memorize grossing techniques for every type of specimen, that kind of stuff you learn on the job.

 

[wild0ne]

A good work ethic and attitude can go a long way.

For 1st year, Robbins can be very relevant and useful.

 

[rirriri]

The social aspect of residency is HUGE. I cannot overstate this enough.

Do NOT be that guy/gal who never attends parties, never goes out for a night to have dinner and hides in the shadows studying slide sets.

Residency is not your undergrad O-chem class, you need recommendations, connections and favorable personal opinions to land jobs.

You dont have to be at a disadvantage being Muslim, Mormon or Adventist. You dont have to be excluded because you have 3 rugrats and a 19-year old wife at home. Make the effort, that is the important part. Even if it is going out for a movie and a burger (or veggie burger or whatever you hippies eat). Its not an all-or-nothing situation.

TOTALLY agree.

Too many Pathologists hide away and don't even know how to communicate with their colleagues or others........LEARN HOW TO TALK and learn how to chill out and take it easy.

Life doesn't ONLY revolve around work......