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danaphosaurus

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We were having a discussion among the residents and our program director about the number of cases read per month vs the number we cut-
We were wondering how many cases other programs are reading per month and the number of cases grossed in per month (in absolute number)-
Thanks for your help
 

PathOne

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An average would make little sense, as it very much depends on the case-mix. And a range would be senseless. E.g.: Some may do 20-30 cases/day on average, while others would consider a normal day 200 cases (that would be in Dermpath). Also, there's obv. a difference between cases and slides - which number are you looking for? Some attendings will order a multitude of recuts for IPOX and other special stains, while others rarely do that. Finally, you have to look at how many consults they do at a specific setting, as these can obviously be more time-consuming.
So I think it'll be very difficult to come up with a meaningful number...
 
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112641

Funny we had no problem tracking the numbers of cases that we cut and the number read the next day.. it was simple.. we counted the number of cases that we cut the day before.. then counted the number of cases we read the next day. We are having problems because the PD thinks the percentages are low..which they are considering we do all the work for a large private practice including GI pour-throughs, small bx's, emc's ecc's, placentas, etc. So we were hoping rather than getting pontifications about the philosophical ramifications and pitfalls of the numbers, of which we're all aware, that we could get some help from people at other programs about what the actual number of cases you cut in in a typical day (knowing that not every day is typical.. as if Dr's needed reminding of that) and then how many of those you "typically" read the next day.

Not that demanding a question I would say and if anyone would be so generous it would help the residents at our program greatly in trying to refine the surgical rotaion here.
 
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yaah

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Residents see nearly all the cases grossed in here - probably about 90%, but when you take out neuropath, opthalmic, and medical renal it's probably closer to 98-99%. And we can see those if we want.

I'm not sure it is an easy thing to count. We have about 8 different surg path services. I suppose someone with access to the LIS administrative options could get a count, but if a resident were to do this we would have to go in and physically count. Not about to do that.
 
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112641

Residents see nearly all the cases grossed in here - probably about 90%, but when you take out neuropath, opthalmic, and medical renal it's probably closer to 98-99%. And we can see those if we want.

I'm not sure it is an easy thing to count. We have about 8 different surg path services. I suppose someone with access to the LIS administrative options could get a count, but if a resident were to do this we would have to go in and physically count. Not about to do that.

You don't log your cases there?!?!?!? How do you track what you do from month to month?

Anyway I suspected the percentage would be way higher at any university.. but I'm not sure that assuming you're at a university program is correct or not... what we're looking for is absolute number as well as the percentage. Although at this point it is seeming to matter less and less because the changes being proposed seem much more in line with reality than what they started out as.
 

yaah

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Why would I need to track it? I don't need to log whether I grossed in and signed out a Whipple in a certain week. We don't specifically track cases that we have done, it's unnecessary in our system and for our training. Sure, I keep track of interesting ones, but not much beyond that.
 

CameronFrye

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We use Copath, which allows you to search for the cases you've signed out, and it looks like I'm averaging around 350 cases each surg path month. As for the questions about grossing, I have no idea. I don't gross any of the small biopsies and the "mains" grossing is divided up between two PA's, the grossing resident, and sometimes the frozen resident, so it's hard to determine without going back through every case.
 

PathOne

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Not that demanding a question I would say and if anyone would be so generous it would help the residents at our program greatly in trying to refine the surgical rotaion here.

OK, lemme try again. Tell me what number you're looking for, and I'll almost guarantee you that I'll get you whatever answer you're looking for. Do you include PAP-smears? That's a great way to boost your number. How do you count heme workup on a patient? As one case, or each test separately?

Guess what? For board eligibility, you need a fixed minimum of autopsies (20), but not a fixed minimum of slides/cases per day/per year/residency, whatever. Why? Because the number is pretty meaningless.
The interesting question is, if Residents (or Fellows) gets exposure to a sufficiently wide variety of different tumors. I can easily find some community program that has huge numbers, but is essentially a screenining facility, where Residents simply don't see enough variations, or get the chance to follow thorough on the difficult cases, because they're sent away for consults. Conversely, you could go to a über-specilized cancer center, where you see an abundance of really weird stuff, but not your normal, run-of-the-mill cases.

But let's just try to play the game:
BWH sees 65,000 surgical, 65,000 cytology and 9,000 cytogenetics specimens and over 300 autopsies per year.

Mt. Sinai (NYC) claims to have the busiest dept. in the country. They have 110,000 surgical specimen examinations, 6,500 operating room consultations, 65,000 cytopathology examinations and 250 autopsies

Soo, raw numbers:
Mt. Sinai has 69 pct. more surgicals, excl. frozens.
BWH has 14 pct. more cytos, incl. cytogenetics.
BWH has 20 pct. more autopsies than Mt. Sinai.

But wait! How many people do they have tooking at that volume?

BWH has 90 faculty, 30 consultant faculty and 45 residents and clinical fellows. Mt. Sinai has some 60+ faculty, 20 residents. Soo, do you adjust your numbers for that? Both have consults, but BWH has much more highly complex consult volume than Mt. Sinai. How do you adjust? BWH arguably have the finest expertise in the world in some subspecs, notably soft tissue & bone, which are notoriously time-consuming buggers. Do you adjust for that, and if so, how?

I understand that OP + Gioivoni isn't trying to determine if they work for the busiest department in the US or not. But I'm still arguing that raw numbers are nonsensical because:
A) They cannot really be reliably computed.
B) It's not really important. What IS important is if the Residents gets exposure to a wide case-mix veriety, and actually get the chance to develop their diagnostic skillz. I.e., that they're not left in a corner doing essentially screening (or scut) work, and that attendings actually TRAIN them in a constructive manner.

I do appreciate the desire to compare the residency experience at one dept. compared to others, or to a national average. However, case-counting just isn't the way forward. Quantitatively, you could try to look at board scores of your dept. compared to the average/median, and qualitatively, you could try to do a survey of attendings who have trained in your facility, and ask for weaknesses and strengths of the program (the latter would obviously not take subsequent improvements into account, but would still be helpful).

Of course, this would be time-consuming. But in a country obsessed with rankings, I guarantee you that the reason why there's no "US NEWS" ranking of path departments is, that there's just no way to easily and reliably compare Residency programs. Sorry.
 

Gyric

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Well I agree with some points about the usefullness of an individual set of numbers, but we are not talking about a well-controlled analysis for publication and I dont think we are trying to rank programs in any order, the op just wants ballpark numbers to know where they stand, so caveats aside:

As a resident I am currently cutting 15-20 specimens per day (whipple, breast, mandible, larynx, complex pelvic resections, etc) and the PAs cut around 20 easier bigs (placentas, prostate, nodes, neuro, etc). I sign out all of those cases (30-40) on my bigs sign out day. All biopsies are cut in by seperate PAs, I sign those out on my biopsy day (not sure how many, probably 100+ cases). All transplant/renal biopsies are handled by a different resident and all derms go to dermpath, but that is all grossed by PAs, not sure the numbers.
 
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b&ierstiefel

Agree with PathOne...these numbers are too complex to count.

PathOne, you seem to know a little too much about BWH...freaky...

BTW, autopsies have dropped to about 160 this past year...the days of 300+ autopies/yr are over.
 

sohsie

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On this years board application, they asked me how many surgicals I did, along with # of bone marrow biopsies I performed, # of FNAs I performed, and # of clinical consultations or some such thing (I may be missing something). Dont remember if they asked how many cytology cases I saw. I just guesstimated the big numbers. They dont list any requirements for how many you have to have (except autopsy -50)
 
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