Duke's Program

[LoaLoa]

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Hey, I'm currently a resident at Duke and I may be able to shed some light on the program. There had been some discussion in another thread about problems with specimen volume due to UNC's proximity. To be honest I'm not that sure about the raw numbers. As a resident, I certainly don't feel any shortage of specimens. I will say that on surgical pathology at least, residents get tons of cases and some days you simply won't have time to preview everything--even if you stayed there all night long. It can be frustrating, but in the long run there's no question in my mind that it's for the best. Our faculty will surely be able to let you guys know more raw numbers when you apply. As far as grossing specimens goes, we have it pretty nice here. The residents gross in only large cases (at Duke, it's different at the VA) and the PAs do a large portion of the routine larges (like grossly normal placentas) and most of the smalls. The PA school which somebody mentioned is an asset, in my opinion. There are three or four PAs who work full time in the lab who essentially have done nothing but gross specimens all day for years, and they are extremely knowledgeable and willing to teach. Of course, we also have attending pathologist support whenever we need it. I would definitely say that at Duke the focus is on "scope time" over grossing time. On an average day on Surg Path I spend about 5 hours previewing, 2 hours signing out, three hours grossing, an hour eating / wasting time, and another hour or so doing scut like getting paperwork together for my cases. I know this info is Surg Path focused, but that’s what I’ve been on lately and it’s fresh.

As far as problems with the program that someone mentioned in another thread, I can say that as a junior resident I have not seen any of those things firsthand. In my opinion, the quality of the faculty I have encountered has been mostly excellent. They are all friendly and considerate and the relationships between faculty and residents are collegial. There are a few weird ones and the occasional jackass, but hey, this is medicine we're talking about. I don't know, the program could have had problems in the past, but I'm not aware of any current stuff.

Obviously I have a vested interest, but I can say that I think the residents at Duke are really good. We have good relations with our colleagues in the other specialties. Anyway, there are some top-notch people here with excellent qualifications, and they are all pretty cool people. (Well, "cool" is relative in our field, I guess....nerds) We are a pretty close-knit group. Maybe 1/4 of us are M.D./Ph.Ds, and about 1/2 interested in academics and 1/2 private practice. We do stuff outside of work like a book club (last book--The Curious Incident of the Dog in the Nighttime) and the Durham Recreational Dodgeball League (if you can dodge a wrench, you can dodge a ball, baby), and a bunch of us are amateur musicians. There are a couple of computer nerds among us. We drink beer together fairly routinely. Residents in years past have ended up in great places. Of last year's class, one is doing a Blood Bank fellowship in Washington, another is a Dermpath fellow at Duke, another is a Neuropath fellow at Hopkins, and another is a Junior Faculty member at Duke. This year's seniors have offers for Cytopath, Hemepath, and Dermpath fellowships at different places and the others I think are going into private practice.

There is surprisingly little interaction with the other residents in this area. We Duke people do a month-long forensics rotation at UNC, and other than that we are fairly isolated from one another. We have essentially no contact that I know of with Wake Forest. As far as how the two programs compare, I honestly don't know. I have heard second-hand that we have more "scope time" during our early years and they do more grossing, but that is total hearsay. Honestly, I think it would be cool to start up some interprogram conferences and such. Hmm..

Anyway, I interviewed everywhere. The Hopkinses, the Brighams, the Mass Gens, Chicago, Wash U, New Mexico, UTSW (a great program), Michigan, and about five others. For what it's worth I think Duke is absolutely a great place and I have no regrets. I have no doubt I'll be well-trained and will have plenty of opportunities when I'm finished. I'm having a great time and learning a ton here. I would definitely rank it #1 again. This is pretty much a universal sentiment among our residents. I know some of us have put reviews on Scutwork.com lately that have a little more info if you're interested. I don't know about whether Duke is stingy with interviews or not, as somebody mentioned in another thread. Anyway, I hope everybody that's interested gets a chance to come see the place. Take care and good luck with interviews.

 

[drPLUM]

You have no idea how helpful you have been with this post. I have a strong interest in Duke and I was discouraged to hear negative stuff about it. It sounds like place I'd love to be. The times I have heard negative stuff, people have not given specific examples of weaknesses- which makes me wonder if they are just spreading rumors with no substantial information. If only I could get Duke to offer me an interview and go see for myself. Thanks again and maybe this will put some of the rumors to bed.

 

[ChipLeader]

You have no idea how helpful you have been with this post.

I second this sentiment. Thanks for the post LoaLoa. I look forward to visiting the program and seeing for myself...

 

[sapience8x]

i am thinking about doinng an away rotation in pat at duke next year. are there any specific electives that would give me the exposure i need to the people who make the decisions about who gets in? surgical, forensics, etc? or would i get interaction with most people in the dept no matter what rotation i do?

 

[GreatPumpkin]

I second Loa's assessment. Duke has a great program. Though, I am not there we hear lots about Duke and meet plenty of ex-Duke folks.


I wish we had a PA school. 🙂

 

[b&ierstiefel]

I second Loa's assessment. Duke has a great program. Though, I am not there we hear lots about Duke and meet plenty of ex-Duke folks.


I wish we had a PA school. 🙂

Word up. I think that there needs to be a good balance between grossing responsibilities and previewing responsibilities. It's good that Duke has a strong PA school and great PA support...hence, one would predict that this lessens the grossing responsibility burdens on Duke residents. I never thought that grossing less was a weakness.

Grossing is scut!

 

[GreatPumpkin]

You are preaching to the choir! I bet I have grossed in hundreds upon hundreds of biopsies, appendix, tonsils and gallbladders. Not the best use of my time.

You definately need to do some grossing, but looking at slides is much much more important.

 

[b&ierstiefel]

You definately need to do some grossing, but looking at slides is much much more important.

Absolutely. It would be nice to be able to pick and choose which educational specimens you can gross in. After grossing in many colons or kidneys, you have that down and it becomes more routine. You can dish some those off to PAs in a fashion that workload is nicely distributed. That way you can spend more time with complicated specimens such as Whipples and head/neck specimens without knowing in the back of your mind that you still have to cut in 3 colons, 2 pneumonectomies, and a hemorrhoid by the end of the day.

Here we don't necessarily pick and choose but we have several PAs who will gross in the more routine cases and we will get the more educational (and usually complicated) cases. It's not that it's because they can't do it. Hell, they can gross anything 10 times faster than any resident!

 

[cytoborg]

Well I'm glad to see that finally some of the residents have posted on Scutwork! I've posted about this in the past, but it's worth saying again for the new crop of interviewees - Duke is an excellent program. LoaLoa gives an acurate picture of the AP side of things. Scope time is the priority, along with grossing big interesting specimens. Several key faculty members have made it their mission to minimize scut in the program and maximize learning, and it really shows. And they have no problems whatsoever with their specimen numbers - they have about twice the surgical volume of UNC, in fact. With that kind of volume, the residents could be completely overwhelmed in the gross room, but they're not because the program actually cares about resident learning and recognizes the importance of PAs. You will not waste your time (and yes, it IS a waste of time) grossing biopsies, placentas, gallbladders, etc. Once you have mastered those, the PAs do them. Those who try to tell you that grossing such specimens is important to your learning are full of ****. You get protected learning time every single morning to preview your stuff, from 9 am until signout at 1 or 2. Compared to other programs, this is a TON. You still may not have time to preview everything as LoaLoa mentioned, depending on whether you want to come in early before conference in the a.m. but you will still get to see and learn a lot. All that said, no program is perfect, and Duke has drawbacks like anywhere else, it's just a matter of what your priorities are. Please note that UNC is also a good program, with a fabulous group of residents (not to mention just about the most beautiful view from an autopsy suite anywhere) but it's very different from Duke. If the "Duke way" appeals to you, then UNC might not so much, and vice versa I'm sure. If you're seriously looking at Duke and UNC I recommend doing rotations at each if you possibly can.

 

[LoaLoa]

i am thinking about doinng an away rotation in pat at duke next year. are there any specific electives that would give me the exposure i need to the people who make the decisions about who gets in? surgical, forensics, etc? or would i get interaction with most people in the dept no matter what rotation i do?

That's a good question. I know that most of the people I know who did rotations as a medical student and then matched here rotated in Surgical Path. The way it's set up here, you will probably do four one-week rotations on different services and will get to know a large percentage of the attendings and residents. I know that many of the surgical pathology faculty are influential in the resident selection process. Another rotation that might be good (though I don't know if we usually have medical students on this service) is hemepath. The program director is a hemepath attending.

One thing to remember if you're considering coming here is that this is a fairly small department, and everyone knows everyone. I guess this same point goes for most places, but remember that it won't take you long to develop a reputation, good or bad. That can be extremely helpful for the match if you do well, and can help pave over a few potholes in a CV if necessary.

 

[Big Daddy]

I am also a resident at Duke, and I love it here! I think LoaLoa gave a very accurate description of the AP side of things here. The emphasis is really on microscopic interpretation.

Several of our fellows who have come here from other residency programs (including UNC) have commented that as Duke residents, we get much more "glass time" than anywhere else with a similar surgical volume. On the flip side, I feel completely comfortable grossing any specimen, since the ones we do gross tend to be the more complicated ones. I was grossing Whipples and laryngectomies in my first month on surgpath, and still had the time to preview most/all of my caseload before signout.

As a further comment on doing an away elective rotation, I also believe that a month of surgpath is the way to go. There is no better way to see a training program "in action" than to actually spend time with the residents every day. It is not only an opportunity for the student, but also for the residency to see you in action (hopefully that is a good thing!)

Definitely check out our reviews on scutwork.com; two of the current first years and I have put some detailed posts there for folks who are interested.

 

[EvilNewbie]

You know what the weird thing is, it sounds just like my program. Maybe anyone that is happy where they are at have the same kind of sentiments? A better questions instead of saying that you have too much to preview is, how many cases you are going over in a day and on what service (if you are doing subspecialty signouts). Depending on the service it can be light or it can be heavy and from what you are saying, I am thinking you are seeing 50 cases everyday and have osteosarcs, hemangiopericytoma, M7 AMLs on a regular basis which I think is a little misleading. We have reached 50k specimens already and expect it to reach 60k within a month. Making it close to or over 70k specimens for the year. Even then I don't see some rare stuff often (or at all). Quality and quantity is a better marker than just quantity.

 

[sapience8x]

so do you have any tips for doing well if i do a rotation there? first i am going to do a rotation at home so hopefully i'll learn some of the ropes. i just dont' want to do anything stupid and mess up. any ways to stand out favorably?

 

[LoaLoa]

so do you have any tips for doing well if i do a rotation there? first i am going to do a rotation at home so hopefully i'll learn some of the ropes. i just dont' want to do anything stupid and mess up. any ways to stand out favorably?

I think making a favorable impression here is the same as it would be anywhere--work hard and be energetic, be interested (or, failing that, act interested), try to make some good acquaintances among the residents and faculty, show up to the conferences, and be friendly. Nobody will really fault you for not knowing much pathology or histology--after all, you are there to learn those things--and as long as you are reasonably quick on the uptake, you shouldn't worry about this aspect of the rotation too much.

I know most of the med students who've rotated at Duke during my time here have had fun, productive months. I'm glad you're interested in coming for a rotation.

 

[LoaLoa]

You know what the weird thing is, it sounds just like my program. Maybe anyone that is happy where they are at have the same kind of sentiments? A better questions instead of saying that you have too much to preview is, how many cases you are going over in a day and on what service (if you are doing subspecialty signouts). Depending on the service it can be light or it can be heavy and from what you are saying, I am thinking you are seeing 50 cases everyday and have osteosarcs, hemangiopericytoma, M7 AMLs on a regular basis which I think is a little misleading. We have reached 50k specimens already and expect it to reach 60k within a month. Making it close to or over 70k specimens for the year. Even then I don't see some rare stuff often (or at all). Quality and quantity is a better marker than just quantity.

To elaborate on my above post: At Duke, surg path is divided up into several subspecialty services: Service 1 (mostly breast pathology), Service 2 (bone and soft tissue, prostate, thyroid, and other miscellany), OB/GYN, GI, Thoracic, etc. We rotate between these services on a weekly basis. The services that are usually the busy ones (in my experience) are GI, OB/GYN, Breast and Service 2.

Or course you are correct in pointing out that we, like everyone else, see common cases more commonly. However, as a major research and referral center, Duke attracts a large number of both routine and unusual cases. In my experience, it's a very rare day when I see nothing new or interesting. I have been very happy with the quality of the specimens I've seen here.