Confused and looking for advice

[Cica]

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Hey

I am turning to the forum for some advice/questions. I work in a small dept. (no in N. America) where I am the first resident and the only resident with 4 senior pathologists.My responsibilities include grossing 4 hours daily, autopsies (all of them - when we have them), taking part in frozen sections and FNAC. Alongside I have to be at some meetings and lectures week. We have 8 hour long days with 30 mins. lunch.

I am wondering how do I find time to do everything and finish everything in time? I am left with roughly 2 hours a day after the grossing and lectures (not on days with autopsies). Then my responsibilites are do to autopsy micro and reports plus I am supposed to start doing histology.

Can someone tell me how it works there with you guys, I know you have much longer working hours etc.Any tips or advice? On the other hand, I find that my seniors do not communicate and that causes more issues, have brought it up but not one wants to discuss it openly cause of conflict. I feel a bit low and am wondering if I made the right decision by being here (which is sad). Also, I feel like grossing is something that is looked down upon and that is something only residents should do cause they are too good for it or something like that. I dont know what to think. Also, we get 4 hours a week to do reading which I have to take but how do I keep up with everything????? Is it doable????????

Any constructive advice or tips are welcome.

Thanks in advance.

 

[deleted314957]

you are in a program that sucks and you need to get out of there.

 

[Euchromatin]

Hi Cica

Just to clarify - your daily schedule (assuming you don't have an autopsy) is something like this:

8-12: grossing
12-12:30: lunch
12:30-3:30: lectures/meetings
3:30-5:30: only remaining free time to look at slides, read, do autopsy paperwork, etc.
Plus getting interrupted to look at frozen sections and/or FNAs

That sounds terrible and I have several questions. First, if you are the only pathology resident in the department and there are only 4 attendings, how is it possible to have 3 hours of lectures and/or meetings/conferences daily? What kind of lectures are you getting? How often do you get autopsies? Do you preview your surgical cases; if so, when? When do you sit with attendings at the scope and learn histopathology/discuss your cases with them? Are you dictating reports?

Here in the U.S. it is a requirement of the ACGME that residents preview ALL of the slides from cases that we grossed ourselves BEFORE the attendings sign them out. Depending upon when the slides become available in your department and when the attendings expect to get them, you could probably make time to look at your cases either in the evenings or early morning - I know when we are on the surgical pathology service at my institution, we expect to work 11-12 hour days, minimum, not 8. Also, if you have been doing nothing but anatomic pathology all year, you should have had enough experience by this point to be completing dictating all of your cases, knowing more or less what immunostains need to be ordered, etc. and the attendings shouldn't have to do much on most routine cases other than look at the slides to verify your diagnosis +/- minor changes and push the "sign out" button.

In terms of grossing, there have been plenty of other threads on this board on which people have argued what the "correct" amount of grossing is for residents and how educationally beneficial it is vs. just saving the department money they would otherwise have to spend on PAs (pathology assistants) to gross. Generally speaking you want to do enough that you are very familiar and comfortable with all different kinds of specimens - from tiny biopsies to complicated surgical resections and you know what needs to be described, what sections need to be taken, etc. Once you've reached that point, doing routine specimens (i.e. tiny biopsies, placentas, gallbladders, appendixes, etc.) daily is probably not educational for you, although more complex cases still might be.

 

[TMZ2007]

From what I saw when I rotated in England (granted, not Scandanavia) during med school, pathology post-graduate training is much more of a free-form, apprenticeship-type of deal without specific monthly rotations through the various lab departments. Sounds like something similar is happening for the original poster.

In the US we typically have multiple residents in the department, at multiple levels of experience so as to spread the work around evenly (and avoid the kind of problems you are experiencing). If you were at a larger hospital/training institution, would there be more trainees available? If so, maybe you need to try to transfer to a bigger place.

Or is the typical work arrangement for pathology residents in your part of the world? It doesn't sound like you have enough time between 8:00-17:00 to get stuff done. If you are not going to move to a different hospital, you may have to stay much later on a daily basis to read/study/prepare more.

 

[2121115]

Here in the U.S. it is a requirement of the ACGME that residents preview ALL of the slides from cases that we grossed ourselves BEFORE the attendings sign them out.

Trival point ion the grand scheme of this thread, but this is not true.

 

[Enkidu]

Also, we get 4 hours a week to do reading which I have to take but how do I keep up with everything????? Is it doable????????

It sounds like you have more than 4 hours a week to do reading. If you're only working 8 hours per day, then what is stopping you from reading 20 hours a week?

 

[Cica]

Hey

So the lectures are not just for our department, every other wednesday its external lecturers, we have internal pathology lectures twice a week (not always though), once a month (I think) journal club for us, every friday for the whole hospital, every wednesday conference for breast pathology, once a month for urological, once a month immunology and once a month molecular biology.

We are supposed to do 200 autopsies in a span of 4 years and our dept. gets around 50-55 a year. On autopsy days, I am done after 12 (or longer, depends on the case) then I eat and go and do the report. And some paperwork.

The sad part is that we in between start with say 5 surgical or biopsy cases but then ther eis always the pressure to get the autopsy reports out that they have been putting if off. The deal now is that when I get my 5 cases, I am supposed to look at them and then go to attending and discuss with him or her and then write the report. Thats how we do it. I discuss the gross, and have been writing autopsy reports and my own surgical preps cause we were short a secretary up until now. But I am going to dictate from now on 100%.

Since we are a small hospital, we dont get all kinds of surg. preps. So I have seen alot of the kinds that we do get here, and I can imagine in the long run its not that educational. Also, the biopsies that I have started getting now are mostly skin, GI or gyne. I order immunos if needed after the attending looks at them. And we do not have pathology assistants. For reading, I get 4 hours a week plus 3. The rest is up to me.

Hi Cica

Just to clarify - your daily schedule (assuming you don't have an autopsy) is something like this:

8-12: grossing
12-12:30: lunch
12:30-3:30: lectures/meetings
3:30-5:30: only remaining free time to look at slides, read, do autopsy paperwork, etc.
Plus getting interrupted to look at frozen sections and/or FNAs

That sounds terrible and I have several questions. First, if you are the only pathology resident in the department and there are only 4 attendings, how is it possible to have 3 hours of lectures and/or meetings/conferences daily? What kind of lectures are you getting? How often do you get autopsies? Do you preview your surgical cases; if so, when? When do you sit with attendings at the scope and learn histopathology/discuss your cases with them? Are you dictating reports?

Here in the U.S. it is a requirement of the ACGME that residents preview ALL of the slides from cases that we grossed ourselves BEFORE the attendings sign them out. Depending upon when the slides become available in your department and when the attendings expect to get them, you could probably make time to look at your cases either in the evenings or early morning - I know when we are on the surgical pathology service at my institution, we expect to work 11-12 hour days, minimum, not 8. Also, if you have been doing nothing but anatomic pathology all year, you should have had enough experience by this point to be completing dictating all of your cases, knowing more or less what immunostains need to be ordered, etc. and the attendings shouldn't have to do much on most routine cases other than look at the slides to verify your diagnosis +/- minor changes and push the "sign out" button.

In terms of grossing, there have been plenty of other threads on this board on which people have argued what the "correct" amount of grossing is for residents and how educationally beneficial it is vs. just saving the department money they would otherwise have to spend on PAs (pathology assistants) to gross. Generally speaking you want to do enough that you are very familiar and comfortable with all different kinds of specimens - from tiny biopsies to complicated surgical resections and you know what needs to be described, what sections need to be taken, etc. Once you've reached that point, doing routine specimens (i.e. tiny biopsies, placentas, gallbladders, appendixes, etc.) daily is probably not educational for you, although more complex cases still might be.

 

[Cica]

We do not have to review ALL the preps that we have grossed. Just the ones assigned to us.

 

[member0007]

ask for help! maybe, some of the attendings would assist with grossing and performing an autopsy or two here and there.... it's not that hard to do and i am sure that they are dying to roll up their sleeves and get down n dirty 😉

 

[Cica]

ask for help! maybe, some of the attendings would assist with grossing and performing an autopsy or two here and there.... it's not that hard to do and i am sure that they are dying to roll up their sleeves and get down n dirty 😉

I do not know how it is in North America, but here it is the residents that do the gross work and the autopsies. And with falling numbers of autopsies each year (coupled with the requirement of 200 per resident), they want the residents to do most of them. Also, they are more than willing to help out (by guiding, etc.). But on the other hand as opposed to the norms in bigger hospitals, the attendings have been having to do both autopsies and gross themselves, till I showed up (their first resident).

 

[mlw03]

Autopsy requirement in the US is 50, and many residents only get that by doing a month or two at their local medical examiner or coroner's office. Don't know how it is in Canada, but should find out soon and can post that. 200 autopsies is actually the requirement for forensic pathology fellows to do in their one year of training. 200 autopsies for a pathology resident would just be impossibe in the US given the present autopsy rates.

 

[Cica]

Autopsy requirement in the US is 50, and many residents only get that by doing a month or two at their local medical examiner or coroner's office. Don't know how it is in Canada, but should find out soon and can post that. 200 autopsies is actually the requirement for forensic pathology fellows to do in their one year of training. 200 autopsies for a pathology resident would just be impossibe in the US given the present autopsy rates.

I have only been in Pathology for about half a year but I have been told that doing 200 within the 4 years is becoming a problem cause of declining rates. For forensics, I think they have a higher requirement that general pathology.

 

[thebouque]

Autopsy requirement in the US is 50, and many residents only get that by doing a month or two at their local medical examiner or coroner's office. Don't know how it is in Canada, but should find out soon and can post that. 200 autopsies is actually the requirement for forensic pathology fellows to do in their one year of training. 200 autopsies for a pathology resident would just be impossibe in the US given the present autopsy rates.

In Canada there is no autopsy requirement. However, since most programs are 4 years AP (+ 1 clinical year) and we have a 2 months forensics rotation (or its equivalent), residents end up doing a lot more than 50 autopsies during their training.

 

[Euchromatin]

Trival point ion the grand scheme of this thread, but this is not true.

From the "ACGME Program Requirements for Graduate Medical Education
in Anatomic Pathology and Clinical Pathology" on their website - in the "Patient Care" section (emphasis mine):

"Residents will examine and assess at least 2,000 surgical pathology specimens during the program. This material must be from an adequate mix of cases to ensure exposure to both common and uncommon conditions. Residents should formulate a microscopic diagnosis for cases they have examined grossly. Residents should preview their cases prior to sign out with an attending pathologist;"

I guess it does say "should" and not "must," but I still think that would qualify as an ACGME requirement as I had previously stated. I think one of the main educational benefits of grossing is then seeing what your own slides end up looking like. This allows you to see the direct results of your own technique - both mistakes (i.e. cutting a fatty section too thick, resulting in a hole because there was insufficient time for fixing/processing; cutting an inked section unevenly, resulting in missing ink/confusing orientation; etc) and good work. Don't get me wrong, I don't think most programs expect their residents to follow up on cases they grossed while on call (esp if said resident is on a CP rotation or something), but we see the micro for all of the non-call cases we gross, as well as the micro for numerous other cases grossed by our PAs.

 

[pbp4]

sorry but if you want to be functional when you finish- give up on the 8 hour work day- surg path takes time and you need to put in the time now (with someone looking over your shoulder) or later on your own.

 

[Cica]

sorry but if you want to be functional when you finish- give up on the 8 hour work day- surg path takes time and you need to put in the time now (with someone looking over your shoulder) or later on your own.

I totally agree, that is the case in any speciality (esp. Pathology).