analyzing residency programs by the number

[sapience8x]

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i was looking on pathologytraining.org and printed out some information about some programs. part of the information is to tell how many surgical specimens, and autopsies, etc. what are average numbers for these and how should I interpret them? what numbers would enhance my learning experience? what further questions should I ask about these numbers when on an interview?

 

[djmd]

i was looking on pathologytraining.org and printed out some information about some programs. part of the information is to tell how many surgical specimens, and autopsies, etc. what are average numbers for these and how should I interpret them? what numbers would enhance my learning experience? what further questions should I ask about these numbers when on an interview?

There is no such thing as average numbers. The importance is not really number of cases, but types. 20k of galbladders is not going to help you be a well rounded pathologist.

Generally higher voulume is better as is more complex cases, but with limits. You don't want to be worked to death grossing.

questions:
Case variety, complexity, patient population served
to residents:
Work load, the latest they stay on average (and worst case)

most programs have 25-50k cases per year. Larger places like Pitt 65k, Cleveland Clinic 80-85k, and apparently Mayo does 165k (with consults).

 

[sapience8x]

so what kind of patient population served would be best to have in a residency program?

 

[yaah]

so what kind of patient population served would be best to have in a residency program?

Best to do residency in a referral center - that means patients come there for weird diagnoses, difficult surgeries, dilemmas, etc. Many programs, for example, won't expose you much at all to things like bone tumors, sarcomas, pancreatic resections, etc.

In terms of numbers, what is said above is good advice - actual "numbers" are not as important as what they represent. However, attendings have told me in the past that if a program sees more than 20k surgicals/year, they will generally provide a sufficient volume for training variety.

 

[Gene_]

Just for reference, my program does around 30k, and there's plenty of specimens with good variety.

 

[djmd]

Best to do residency in a referral center - that means patients come there for weird diagnoses, difficult surgeries, dilemmas, etc. Many programs, for example, won't expose you much at all to things like bone tumors, sarcomas, pancreatic resections, etc.

In terms of numbers, what is said above is good advice - actual "numbers" are not as important as what they represent. However, attendings have told me in the past that if a program sees more than 20k surgicals/year, they will generally provide a sufficient volume for training variety.

I forgot to say that anything over the 20-30k mark can be enough. (but unless you are really lucky you will not see as many rare weird cases)

As far a patient population you want a mix.
Referral center, with some local off the street (for boring simple Dx, you will see more of these in private practice), with a patient population that is underserved/ avoids the hospital (higher stage disease).

Someone might complain about that last point, but it makes for better pathology. As it is often noted, you do not want to be an interesting case to a pathologist, because 90% of the time it means Bad news for the patient.

For an actual example of the underserved cases, I grossed in 4-5 laryngectomies as a resident, and the first one I got as a fellow, was way more invasive and destructive, completely eroded the epiglottis and they had to take a chunk of oropharynx.

 

[SLUsagar]

i was looking on pathologytraining.org and printed out some information about some programs. part of the information is to tell how many surgical specimens, and autopsies, etc. what are average numbers for these and how should I interpret them? what numbers would enhance my learning experience? what further questions should I ask about these numbers when on an interview?

Good question. I remember during interviews acting like some hot shot asking all these questions which i was "supposed" to ask, not knowing a damn thing about what to do with the info or how to interpret it.
(so, tell me about how your program addresses informatics... lol)

regarding spec #, a generally WASTED question. I mean you can ask, just b/c formally every damn candidate does, but do realize the already-discussed above many complications regarding this #....many are gallbags, consults, cytos, hell some programs include PAPS in that #.

Better to ask residents how many cases they typical have on a typical signout...and ask about breakdown of biopsies vs. smalls/meds/bigs. and what sorta bigs (i.e. all colons, vs. a ton of soft tissue resections etc).

also ask if/how residents have access to the consult cases. These are like gold i tell you. Here, we've got a weekly consult unknown session where residents get to see the best of the best of the Kempson consult service. I've found myself drooling several times over the rare but textbook cases we sometimes see.

 

[yaah]

I generally asked every attending what the resident/faculty interaction was like (in regards to teaching, conferences, etc), how teaching was made a priority, what kind of projects people did, etc. I agree that the questions about specifics are not that helpful often, either that or the PD will talk about them or you will find them in the material they give you.

I don't think I ever asked about specimen # - that info was always available online or in reference material. Interviews are the time when you are trying to find out if a place is good for you - you are not just there to impress them.

 

[djmd]

My favorite question for judging the program's personality was

"What is you interaction like between..."
residents and faculty.
between residents.

I would usually follow up with social interaction if that didn't come up in the first one.
Most people would talk about how well they got along with staff and other residents.
One program, someone said "I don't get into to many fights with other residents."😱 Nice.

That wasn't an outlier at that program. (at least when I interviewed there)
🙄