Did I go into the right field?

[PathologyRocks]

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Hey all,

I am an intern in Pathology starting my second month in resdiency. I am currently in the Southwestern United States at a solid program. Before starting residency in path, I completed two clerkships in forensic pathology, but none in surg path. My steps were 214 and 216. The people that I work with are friendly and the resident dynamic is good. My chiefs have had excellent luck in securing very respected fellowships.

Here is my problem. I feel like I am the slowest grosser on the planet (to be honest I came a long way since my first month), and I probably am. I can't read a slide to save my own life. At least my co residents who get a question wrong can BS a response. I tend to come up blank. My attendings are starting to notice, and frankly it worries me.

I often wonder if I should have chosen a field like ER, where complex analysis and a ton of book reading isnt required. I am working 14 hour days and having the motivation to read is severely lacking. I read introductory books like the practice of surgical pathology by Molavi and Robbins and I find that they are practically useless 80% of the time.

My attendings are extremely bright and generally very personable, but I feel like a ***** 80% of the time and quitting seems like a viable option.
I have no desire to be the "problem resident" that the program pulls through. Im not looking for sympathy, but honest and frank opinions about you or people you knew who left the field or had second thoughts.

-P

 

[caffeinegirl]

You're first several months of pathology are going to be daunting. And it's completely NORMAL to NOT know anything, especially if you haven't done a surg path rotation prior to residency. You won't have tons of time in your first 2-3 months to read, as you're trying to get adjusted to work flow and a completely different environment. So I recommend that you just hang in there....

Being a first year resident is tough..especially for those types of people who cannot deal with not knowing the answer. I always told first year residents that it's not about the answer! It's about descriptions and pattern recognition. Get immersed in your cases..pick a few that are interesting and that you grossed and spend more time on them. You are definitely not expected to be able to make diagnoses in your first several months of AP. During conferences, the first year should be able to describe the case, and at the end of the year maybe come up with a differential. In AP2, that's when the differential and work up come in.

In my experience as a trainee (and I had a surg path rotation in med school) things didn't start to click for me until well into the second half of my second year of AP. Prior to that I was able to describe things, get pattern recognition on basic stuff, and maybe favor benign or malignant.

We all learn at a different pace. And, at the end of my training we all ended with the same level of knowledge, even if we didn't start at the same point.

So my advice is to bask in this time of ignorance. The expectations are low, and just immerse yourself in this great field. You will get better (both diagnostically and at grossing) over time. If you know everything in your first month then there's no reason to even do residency!! 🙂

PS: The feeling of being a ***** never goes away in this field. I still get cases in which I have been completely stumped. It's this challenge that keeps me interested...and one of the reasons I love this field!

PPS: Also try and focus on normal histology in your first several months...if you don't know what normal tissue looks like, then it's tougher to know abnormal!

 

[Unty]

Hey all,

I am an intern in Pathology starting my second month in resdiency. I am currently in the Southwestern United States at a solid program. Before starting residency in path, I completed two clerkships in forensic pathology, but none in surg path. My steps were 214 and 216. The people that I work with are friendly and the resident dynamic is good. My chiefs have had excellent luck in securing very respected fellowships.

Here is my problem. I feel like I am the slowest grosser on the planet (to be honest I came a long way since my first month), and I probably am. I can't read a slide to save my own life. At least my co residents who get a question wrong can BS a response. I tend to come up blank. My attendings are starting to notice, and frankly it worries me.

I often wonder if I should have chosen a field like ER, where complex analysis and a ton of book reading isnt required. I am working 14 hour days and having the motivation to read is severely lacking. I read introductory books like the practice of surgical pathology by Molavi and Robbins and I find that they are practically useless 80% of the time.

My attendings are extremely bright and generally very personable, but I feel like a ***** 80% of the time and quitting seems like a viable option.
I have no desire to be the "problem resident" that the program pulls through. Im not looking for sympathy, but honest and frank opinions about you or people you knew who left the field or had second thoughts.

-P

No offense but you sound you like you have OCD/anxiety disorder. Just chill out, you are in your second month of residency. If you dont know, say you dont know and go read about it. Residency training is for you to learn and get trained about pathology. You aren't expected to know everything.

 

[blue lobster]

I would assume things will get better with the territory. Time passes, you get more comfortable in the environment, things become much more routine and second nature. You turn into a second year, and as you see the new first years, you will then know how much you've grown in the process.

 

[mlw03]

I'll be the devil's advocate, and say the answer to your question is "maybe." If you're honestly working as hard as you can and you're still falling well behind your peers, maybe pathology isn't for you. However, if you're not giving it your fullest effort, or you're really at a comparable level to your peers, then I agree with the advice to give it a bit more time. Strongly agree with the suggestion to learn normal histology, as well as abnormal but non-neoplastic things. Diagnostic pathology is about time at the scope, so hopefully you're not being overly taxed in the gross room. Give yourself a few more months and re-evalute - that'd be my advice, and in the meantime, work your butt off to see if you enjoy pathology and have the eyes to do it.

 

[caffeinegirl]

Check out the "opus" thread as well

http://forums.studentdoctor.net/showthread.php?t=831236

 

[PathologyRocks]

No offense but you sound you like you have OCD/anxiety disorder. Just chill out, you are in your second month of residency. If you dont know, say you dont know and go read about it. Residency training is for you to learn and get trained about pathology. You aren't expected to know everything.

Im glad you mentioned this. I guess part of the reason why I posted is that instead of being the typical sdn "Neurotic, I hope I did everything right," I am the inverse. I almost feel too comfortable as I dont know anything, and it seems like most of the things I do are wrong, and I dont have that "holy fear of failure" I used to have in undergrad before an exam. More importantly, it's hard to gauge my progress as attendings rarely tell you when you do things right, but always when they're wrong. With 12-14 hour surg path days going home and reading seems like the last thing on my mind. I still havent taken step 3 (all of the other residents in my cohort have due to taking research years before their first year of residency), and I feel totally submerged . I didnt intend for this to be a rant, but I guess it has turned into one.

Thanks

-P

 

[psycho path]

Hey all,

I am an intern in Pathology starting my second month in resdiency. I am currently in the Southwestern United States at a solid program. Before starting residency in path, I completed two clerkships in forensic pathology, but none in surg path. My steps were 214 and 216. The people that I work with are friendly and the resident dynamic is good. My chiefs have had excellent luck in securing very respected fellowships.

Here is my problem. I feel like I am the slowest grosser on the planet (to be honest I came a long way since my first month), and I probably am. I can't read a slide to save my own life. At least my co residents who get a question wrong can BS a response. I tend to come up blank. My attendings are starting to notice, and frankly it worries me.

I often wonder if I should have chosen a field like ER, where complex analysis and a ton of book reading isnt required. I am working 14 hour days and having the motivation to read is severely lacking. I read introductory books like the practice of surgical pathology by Molavi and Robbins and I find that they are practically useless 80% of the time.

My attendings are extremely bright and generally very personable, but I feel like a ***** 80% of the time and quitting seems like a viable option.
I have no desire to be the "problem resident" that the program pulls through. Im not looking for sympathy, but honest and frank opinions about you or people you knew who left the field or had second thoughts.

-P

See how you do after finishing first year. Pathology is a new world, i am still learning after 7 years of practice, everyday things feel different

 

[Euchromatin]

I still havent taken step 3 (all of the other residents in my cohort have due to taking research years before their first year of residency), and I feel totally submerged .

Although I don't know the exact circumstances at your institution, this might explain why you feel really behind the other first year residents. I know of several places (through med student rotations, word of mouth, etc.) that would only take one traditional, freshly graduated MD/DO through the match and all of their other spots would be pre-matched people (often FMGs who were already pathologists in their native country or MD/PhDs) with a ton of prior pathology and/or research experience. I guess you could try and use the other residents in your year as resources if they are genuinely more knowledgeable than you are and willing to help you, but it would certainly make judging your own progress difficult with no one of a similar background to compare yourself to.

I applied for my license in one of those states that allows you to take Step 3 as soon as you'd like, and I took it in October of my first year. It wasn't exactly a "vacation" but I took 3 days off to study + 2 days for the test, which gave me a nice break from anatomic pathology for a week. I felt refreshed afterward and continued to slog it out until my first actual vacation around Christmas.

 

[KCShaw]

Try to back off on the sense of needing to read about everything, and just focus on a couple of different things every few days. Right now most everything is still "new," and there's no point trying to feel like you're supposed to read about -every- new and different case that comes by -and- remember everything. Kinda like the adage of learning a small book very well, instead of a large book not really at all.

If you're spending several hours longer than everyone else grossing, then just focus on improving that. If you can save yourself a couple of hours every day, that's more time to rest &/or review slides &/or read; it can be an exponential difference. If it's any consolation, I was pretty slow as a grosser starting out, but eventually got much more comfortable and faster, which subsequently allowed me to do more outside of the gross room. And of course the slowest grossing resident I ever met eventually landed a dermpath fellowship; grossing wasn't exactly an efficient process for that person, but they managed to focus and do well outside the gross room.

It's true that, in the end, pathology might not be for you. But I would caution against making that determination not even 2 months into residency. Every specialty has its learning curve and its stressors and its moments of making you feel disastrously inadequate. I still shudder to think the number of patients I managed shall we say..suboptimally..during portions of my clinical internship. Thank goodness for interns being supervised. But, I learned, I got better, and a degree of confidence emerged.