Choice of pathology residency program

[Anais79]

Dear Pathologists, I need your input and expertise with choosing the residency program\putting together the rank order list. There are 2 main opinions out there that I heard in regards to path training, and I am wondering what the people on this forum think.

Opinion 1. You must try to get to high volume, tons of exposure big busy program ( such as Yale , John Hopkins or Cleveland Clinic). Preview time in them is limited, and grossing is done late at night quite often, but you will be exposed to a large number of educational cases. According to supporters of this opinion, graduates of these programs have better fellowship options and better employment opportunities.

Opinion 2. High volume, super busy program is good for fellowship, but not for a residency training. One should prefer medium size program with decent amount of time allocated to preview and independent learning to learn the basics of pathology well. Examples of such programs will be Oregon Health and Science U, U of Wisconsin.

Even though it is obvious that a choice of program largely depends on future career plans, I am interested to hear your input on the subject.

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[deleted314957]

you don't need to go to a yale, hopkins or cleveland clinic to see an acceptable # of educational cases. IMO having time to preview all your cases and read up on them is ideal. remember that if the oddball sarcoma is not on your grossing/sign-out list you will still see it at intradepartmental conference ( or should). geography and your "gut feeling" after interview or away rotation is also of very high importance. do not get hung up on a name. you have to be happy there and be able to effectively learn.

 

[yaah]

A smart and motivated resident can make any type of program work to their advantage. If you lack motivation and such, going to a program where you are forced to work harder is helpful, and going to a more individual place or one where you are permitted to slack would be a bad idea for your career (although very nice for your free time during training). It's best to pick a place where you think you fit, you can excel, and where you want to live. It also helps if you have an idea about what fellowship you want to do and what these sites offer, etc. Going to a more elite institution is more helpful if you want to go into academics because it can get you started on connections, projects, etc.

 

[HmanPath]

A smart and motivated resident can make any type of program work to their advantage. If you lack motivation and such, going to a program where you are forced to work harder is helpful, and going to a more individual place or one where you are permitted to slack would be a bad idea for your career (although very nice for your free time during training). It's best to pick a place where you think you fit, you can excel, and where you want to live. It also helps if you have an idea about what fellowship you want to do and what these sites offer, etc. Going to a more elite institution is more helpful if you want to go into academics because it can get you started on connections, projects, etc.

What about in terms of future connections when it comes time to look for a job? I would think that a program from example #1 might have more of them. Also just curious about you opinion regarding location of residency. Say if you wanted to end up in the west coast, would going to a different region for residency and or fellowship be of value? Like adding a different perspective to a group, and possibly going to a program of higher quality than the local program. Thanks.

 

[Napoleon1801]

What about in terms of future connections when it comes time to look for a job? I would think that a program from example #1 might have more of them. Also just curious about you opinion regarding location of residency. Say if you wanted to end up in the west coast, would going to a different region for residency and or fellowship be of value? Like adding a different perspective to a group, and possibly going to a program of higher quality than the local program. Thanks.

If you want an academic job, then I'm sure those connections would pay off. However, if you are thinking about private practice I've noticed that the academic folks don't always know what is going on in the local pathology community. Occasional exceptions.

If you want to be on one side of the country, it's best to start early. I imagine it can be tough to break into the coasts if you do not have any established ties there. The earlier you start, the better your chances are.

 

[yaah]

What about in terms of future connections when it comes time to look for a job? I would think that a program from example #1 might have more of them. Also just curious about you opinion regarding location of residency. Say if you wanted to end up in the west coast, would going to a different region for residency and or fellowship be of value? Like adding a different perspective to a group, and possibly going to a program of higher quality than the local program. Thanks.

I don't think groups would ever hire someone because they came from somewhere else "to add perspective," that doesn't make a lot of sense. Local connections can be important, mostly for reference purposes. If someone you trust says good things about a candidate, that speaks volumes. It also may matter to some groups if you are local because it may mean you are more likely to stick around (and not leave for someplace you would rather be or your spouse wants to be).

 

[SquirrelFighter]

Dear Pathologists, I need your input and expertise with choosing the residency program\putting together the rank order list. There are 2 main opinions out there that I heard in regards to path training, and I am wondering what the people on this forum think.

Opinion 1. You must try to get to high volume, tons of exposure big busy program ( such as Yale , John Hopkins or Cleveland Clinic). Preview time in them is limited, and grossing is done late at night quite often, but you will be exposed to a large number of educational cases. According to supporters of this opinion, graduates of these programs have better fellowship options and better employment opportunities.

Opinion 2. High volume, super busy program is good for fellowship, but not for a residency training. One should prefer medium size program with decent amount of time allocated to preview and independent learning to learn the basics of pathology well. Examples of such programs will be Oregon Health and Science U, U of Wisconsin.

Even though it is obvious that a choice of program largely depends on future career plans, I am interested to hear your input on the subject.

First time poster here.

I am an MD/PhD looking to go into path and I will be applying to Wisconsin in addition to all the "top" programs. I have heard good things about the residency and the PD. Research is of course very strong there and they have AP only option and a year of supported research available. Sample volume and variety are supposed to be relatively good (like around 75,000 surgicals/year, a transplant program, etc.). Madison is also a great city, but winters are surely long and cold. The graduates seem to get their choice of fellowships judging by their alumni page. I think you're smart to think about it (I feel smart anyway). Some downsides I think are that they offer few fellowships themselves and despite their research strength they do not have much of an existing track record of their graduates getting their own labs and R01s (that's a high bar these days). As is true of most programs the majority of applicants do private practice. I don't plan on applying to OHSU.

In terms of your overall question, I would prefer not to be in a program that works me to death for no reason but I also don't want to sacrifice excellent training. From what I've gathered I think some of the west coast schools might thread this needle better than some of the programs that you mentioned in your post. I still be applying everywhere though. It's tough because I personally don't think grossing constantly will make me a better pathologist in the end and I'd like to think I could use that time to be more productive in other areas. I just don't know if that makes me lazy or not. My primary concern with going to a school like Wisconsin is academic reputation compared to Stanford, Hopkins, Penn, etc. The nightmare would be getting great residency training, working with a renowned researcher and doing excellent research with great pubs, and then not getting interviews for faculty positions because I went to Wisconsin and somebody else applied from Stanford, Hopkins, Penn, etc. Does it happen? I'd imagine it does at some schools/departments. That makes me feel like I'm may be limiting my opportunities by not going to a "top" program even though I feel like it won't ultimately affect the quality of my training and I may enjoy my time less.

I think I'll pour myself a drink.

 

[HmanPath]

Thanks for the replies, they have been most helpful. I suppose in terms of "perspective" it was pertaining to working as faculty at the same academic institution where you did residency and only have learned what you know from the other faculty there and not really bringing any new perspective to the table when the tough cases come up. I guess another question I had would be the "portability" of residency/fellowship training. By this I mean if you train at an institution that has a name that is well known around the country and not just locally, would that allow you to look for jobs in a wider geographic area? Thanks.

 

[Inez2000]

If your goal is to run your own lab, you should go to an elite institution, where fellowships are preferentially given to internal candidates, and faculty run funded labs. At a place like Wisconsin you could count on one hand the number of faculty pathologists who have an R01 or some source of significant funding. Nearly all funding at Wisconsin pathology is attained by PhD scientists.The process of getting R01 level funding is so difficult, you need a good mentor, such as that found in elite institutions.

 

[Path hall]

I'm at a big volume place (>100k in-house surgical specimens a year). Its nice to see so many interesting cases, but at the same time, since the volume is so large, I don't feel like I get the opportunity to preview as much as I'd like to. In hindsight, I think the ideal program would be a nice mid-size program with complex cases, and lots of preview time at the scope. Don't get me wrong, though. I like my program and I think I'm getting a good education.

 

[Anais79]

Thank you so much everybody for contributing to this thread! It is so much appreciated. It was also pretty re-assuring in a way to hear that other path applicants are struggling with choices behind the rank order list. I guess choosing a residency position turned out to be so much complicated than I ever thought it would be.

The name matters. I know this, because I am an IMG. What saves me, is 95 percentile on USMLE step 1 and 2, first author publication in a high impact journal and LORs from influential people, yet I know that it is the name of my foreign med school, which by the way was excellent, that will bring me down (Squwirrel Fighter, is that the nightmare you talked about, lol). So coming from this experience I never want to be in the position ever again when where I trained matters more than my IQ and what I actually know and capable of. But the reputation of academia greatly depends on names, impact factors and other rep criteria. I do not want to fall a victim of stereotypes, but I do understand now that if academia is your top option, big name might be preferable. Period.

But, Like Yaah noted, I believe that to learn effectively and acieve your top potential, you need to be in the state of inner comfort, and "want to come to work"- e.g. Not overworked by scut or being depressed from negativity that is so often taking place at high end places. Also, you need time to learn independently and read. You might be a better pathologist this way, but you may not land your dream job.

Choices are hard, and we choose based on life experiences, and most importantly, knowing or not knowing or thinking us knowing what we want. If you ask me, being happy, working in a great team both personally and professionally is so much more important FOR ME. But people are different, and I guess what this thread made me understand is that the right choices differ from persin to person. Thank you for this!!!!

 

[neulite30]

What saves me, is 95 percentile on USMLE step 1 and 2

Out of sheer curiosity, how were you able to find out your percentile rank?

The (now officially irrelevant) two-digit score does not represent this.

Apologies for the digression.

 

[Anais79]

Neulite30, not a problem. It is statistics based on the mean, the SD and the G curve.

Remember the standard distribution curve, and percentile of the population in conjunction with the SD? Your report gives you the average and the SD.

Lets say, USMLE step 1 average is 224, SD is 20.

2 SD is 95 percent of the population, so as long as you are above 224+ 20 *2, or highter than 264, you are in the 95 percentile of the population.

 

[LADuck00]

If you are applying to Wisconsin you should apply to Iowa as well. It's only a 3 hours drive from U. Wisconsin and has a stronger reputation for pathology.

 

[peachesorangesapples]

bump

can more people comment? trying to figure out my ERAS list and it's so hard applying to programs just based on the websites lol

 

[dukeresident]

bump

can more people comment? trying to figure out my ERAS list and it's so hard applying to programs just based on the websites lol

Isn’t that the truth...

 

[pac45]

I would prioritize the following, location (living there during residency, where you want to settle down after), quality of training, fellowships available, and culture/fit, then try to narrow your choices.