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.
