General or sub-spec Surg Path?

[Rustavo]

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I'm currently toward the end of a 10-program interview tour, and am psyched about my decision to go into path! I'm interviewing mostly at the big research university programs on the east and west coasts. One of the tough decisions I'm having in evaluating programs is whether to go for a program with sub-specialized or general surg path. I'd appreciate thoughts from residents who have trained in either type system and what you like or dislike about it.

Thanks

R

 

[yaah]

I wasn't sure I was going to like subspecialized signout, but I end up preferring it. It is just more conducive to learning important distinctions. You do learn in a different way by seeing every type of specimen in one day, but IMHO you learn more when you see similar cases and are able to develop the distinctions between similar cases. You can learn a bit about Ulcerative Colitis, for example, if you are in a general signout and see one case a day. But when you are on GI subspecialty and see five of them a day it is a lot more meaningful because you start seeing the gradation of disease and subtle findings that make big differences.

Some say subspecialty signout isn't the best because it doesn't "prepare you" for a career in general surg path. I think that's bunk - just because you train by seeing a cervical biopsy followed by a GI polyp followed by a lung resection doesn't give you any advantages as a resident. The other advantage is that you often get to sign out with experts in the field. Having experienced both, subspecialty is a big plus.

I would say though that signing out exclusively with one-specialty experts can have its drawbacks - because there are simply a lot of cases that don't fit certain areas, or have features that having experience in other areas would help you more with. But at least at my program, we also have people signing out in subspecialty areas who also sign out other areas, so that drawback is minimized.

Generalized signout always appeals more to younger residents without much experience, because there is more "variety" and it seems like you are getting a wide range of experience. But once you start getting more experience, subspecialty provides a lot more in terms of education.

 

[CameronFrye]

I'm currently toward the end of a 10-program interview tour, and am psyched about my decision to go into path! I'm interviewing mostly at the big research university programs on the east and west coasts. One of the tough decisions I'm having in evaluating programs is whether to go for a program with sub-specialized or general surg path. I'd appreciate thoughts from residents who have trained in either type system and what you like or dislike about it.

Thanks

R

IMO, both styles have their pros and cons, but in the end, I don't think it really matters one way or the other. I'm at a program with general surg path signout, but I think that I would've been perfectly happy at a place with subspecialty signout. I think it's more important to focus on the "personality" of the programs you are looking at and whether or not you get along with the people there.

 

[Gut Shot]

Generalized signout always appeals more to younger residents without much experience, because there is more "variety" and it seems like you are getting a wide range of experience. But once you start getting more experience, subspecialty provides a lot more in terms of education.

Agreed, although the drawback to sub-spec is that you might get quite good at something and then not touch it again for many moons. That seems to be a common theme, both in training and in real life. The core AP rotations at my program are general while the electives are sub-spec. Most of our R4's come back for some general before graduating, in order to brush up before boards and fellowship.

 

[SLUsagar]

again, agreed with above.
also i don't think the type of AP/CP program (straight vs. intermingled) makes much of a diff either. Both have pros/cons, but in the end the institution, namely the attendings and particularly the residents, are the key.

 

[Click Here!]

Since this thread seems to be discussing some of the questions I've had while on the interview trail I'll add another: Do you think the number and variety of hospitals in a program matters that much?

For example, Program A spreads rotations approximately equally between County, VA, Children's, and Private hospitals. Program B spends most time at County, but you still get a couple of months each in the other settings. Program C spends majority of time in Private hospital, but several months of core and elective rotations at other types of hospitals available.

Few programs meet the criteria for A, but is this model really an advantage? Sure seeing the way different systems work is always good, but isn't a month enough? Or maybe if there's a deficiency of particular types of specimens at one of the hospitals, such as breast and gyn at the VAs. But is there anything missing at a typical County or large Private hospital?

OK, I'll stop now. This rambling post brought to you by A (Baylor), B (UTSW), and the letter C (Methodist).

 

[Gut Shot]

Since this thread seems to be discussing some of the questions I've had while on the interview trail I'll add another: Do you think the number and variety of hospitals in a program matters that much?

For example, Program A spreads rotations approximately equally between County, VA, Children's, and Private hospitals. Program B spends most time at County, but you still get a couple of months each in the other settings. Program C spends majority of time in Private hospital, but several months of core and elective rotations at other types of hospitals available.

Few programs meet the criteria for A, but is this model really an advantage? Sure seeing the way different systems work is always good, but isn't a month enough? Or maybe if there's a deficiency of particular types of specimens at one of the hospitals, such as breast and gyn at the VAs. But is there anything missing at a typical County or large Private hospital?

OK, I'll stop now. This rambling post brought to you by A (Baylor), B (UTSW), and the letter C (Methodist).

That's a tough question to answer. When comparing A to B I think you're splitting hairs. I'm not sure about C.

A more relevant question is how much autonomy you'll be granted during your training. Private hospitals can be pretty swanky, but the irony is that residents sometimes aren't trusted (enough) to handle complicated specimens. That's a nice way to stay a resident for well beyond residency.

County may suffer the opposite problem, but at least you get accustomed to stepping up to bat and handling things on your own (even if you screw up sometimes).

Somewhere in between is that elusive balance.

 

[LADoc00]

again, agreed with above.
also i don't think the type of AP/CP program (straight vs. intermingled) makes much of a diff either. Both have pros/cons, but in the end the institution, namely the attendings and particularly the residents, are the key.

"Blended" AP/CP programs ARE better that straight AP then CP training. Whether academics want to accept this or not, I dont care. Its true. Dont insult my intelligence telling me someone who hasnt seen a single surg path case in 2 years while they did pure CP is on par with someone who has been seeing surgpath all 4-5 years.

Programs need to make the change. That is all I will add on the subject.

 

[Gut Shot]

"Blended" AP/CP programs ARE better that straight AP then CP training. Whether academics want to accept this or not, I dont care. Its true. Dont insult my intelligence telling me someone who hasnt seen a single surg path case in 2 years while they did pure CP is on par with someone who has been seeing surgpath all 4-5 years.

I'll buy that for a dollar. I finished blood bank core back in August and it's already slip sliding away...

 

[PathOne]

Here'z yar plan:

18 yrs: High School Valedictorian, Phillips Acad. or other such place
22 yrs: A.B., summa cum laude, double majors, Harvard/Yale/Pton
29 yrs: MD, PhD, summa cum laude, Harvard
29-33: Path, MGH
33-35: Surg path+molec path Fship, MSKCC
35-37: Dermpath, UCSF
37 years: Ooohkayy, perhaps it's time to start earning a buck or two... Oh, wait. Perhaps I'd just take oooonnneee more subspec Fellowship! ;-)

 

[yaah]

Here'z yar plan:

18 yrs: High School Valedictorian, Phillips Acad. or other such place
22 yrs: A.B., summa cum laude, double majors, Harvard/Yale/Pton
29 yrs: MD, PhD, summa cum laude, Harvard
29-33: Path, MGH
33-35: Surg path+molec path Fship, MSKCC
35-37: Dermpath, UCSF
37 years: Ooohkayy, perhaps it's time to start earning a buck or two... Oh, wait. Perhaps I'd just take oooonnneee more subspec Fellowship! ;-)

I met a guy with a resume like that once and he was a douchebag who was always disappointed in how things turned out, and wasn't getting the best job offers, etc. He never made the conclusion that it was because he was a douchebag and people didn't like him. I know many doctors with "prestigious" pedigrees who I wouldn't go to for a UTI.

 

[LADoc00]

Here'z yar plan:

18 yrs: High School Valedictorian, Phillips Acad. or other such place
22 yrs: A.B., summa cum laude, double majors, Harvard/Yale/Pton
29 yrs: MD, PhD, summa cum laude, Harvard
29-33: Path, MGH
33-35: Surg path+molec path Fship, MSKCC
35-37: Dermpath, UCSF
37 years: Ooohkayy, perhaps it's time to start earning a buck or two... Oh, wait. Perhaps I'd just take oooonnneee more subspec Fellowship! ;-)

Most of the people with such a resume end up being one thing: Employees.