Generalist vs. subspecialty sign-out?

[Ludy]

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Hey, just wondering what you all think about the generalist vs. subspecialist model in terms of surg path sign-out. I'm leaning towards the subspecialist model myself -- seems like it would allow for more focused and a greater depth of learning, plus the chance to sign out with an expert in the area. On the other hand, most places use a generalist approach, so there must be some advantages to it... thoughts?

 

[rirriri]

hey Ludy!

it seems to be that (like you said) most places use a generalist sign out method....for the residents in training, it seems a subspecialized sign out would be more advantageous..

Some programs tend to *try* and have subspecialist sign out whenever they can, it's just that there is no organization to ensure this type of sign out day in and day out.

The other problem with this might be that Pathologists themselves may want to see a variety of cases and if, for example, a Breast Pathologist ONLY gets breast cases each and everyday, he/she might start to lose touch with basic pathology of other tissues....so there are advantages and disadvantages.

cheers and i hope you are doing well!
-R

 

[yaah]

I have heard from several folks that one advantage of subspecialty is that you see cases with experts in that area, so that the teaching can be better and more focused. You also will probably spend less time taking the case to a subspecialty consultant when the original attending asks you to. For the attendings who do it, they might be limiting their future career mobility because unless you are a nationally known expert, most jobs involve signing out more than just one area. For residents, that's less of an issue since you rotate through areas. I think one advantage of the generalist sign out model is that it is easier to find attending coverage. If the volume is not high, the GI pathologist on subspecialty signout might get crushed with volume while the soft tissue person has 5 cases.

I haven't decided which I prefer yet. I think for residents both are pretty effective for various reasons, so I personally am not going to let this be a major factor in my decision. I am still debating merits of program size and reputation vs other intangible factors.

 

[Doctor B.]

Our program uses the generalist model and it works pretty well. We have some subspecialization as well; all the kidney biopsies go to only the renal pathologists. Likewise, many (but not all) of the liver biopsies go to our liver pathologists. I haven't had any experience with total subspecialization but I imagine that both models are pretty much equivalent. One thing I like about the generalist model is that you get to see each attending's approach to the same type of specimen. Also, you get to see how a "non-expert" handles certain specimens which is a good experience for those going into general surg path since you will likely be a "non-expert" in most areas. Finally, you often end up showing cases from a certain organ system to the expert in that system anyway so you get that learning and get to compare the non-expert approach with the expert approach.

 

[GreatPumpkin]

We have specialty sign out. I love it that way. Easier to concentrate your reading when your are doing a specific area for two weeks. As a first year it was nice to really get the hang of doing certain specimens, before moving on to another service. When you get 3 or 4 or more hysterectomies in a row you really get the hang of it. Sign out is very efficient we usually don't have cases we need to show around (which can be a real pain in the butt and take up too much of your time) since we are sitting with the "expert". Once in a while when people are on vacation and such we have some of the other specialists doing a service they would not normally do, wow that is painful.

Regardless I think either way would be fine. This would be way down my list of things to evaluate between programs.