Grossing Load

[y2k_free_radical]

I have seen this several times,even in good diagnosticians.My comments reflected my experience,not misogyny.I like and respect many women,starting with my wife.

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[Euchromatin]

This happens to some people; even if you don't know of anyone citing this as their reason for quitting or getting burnt out in their practice, it's not hard to think of this as a possible outcome, specially for some pathologists with poor diagnostic skills, and even for some with average or addequate skills who tend to self doubt themselves too much, or find the burden of uncertainty of diagnoses, specially neoplastic, too difficult to bear. What I can't wrap my head around is you having never heard any colleague complain about or know someone obviously affected from having to deal with uncertainty in diagnosing...

I certainly acknowledge that there are varying degrees of confidence in one's diagnostic skills and varying degrees of comfort with uncertainty. We all have colleagues who may get more stains, levels, peer reviews/second opinions, etc. than others. We're also all somewhat limited by our individual anecdotal experiences I suppose, but I am not aware of anyone I have trained or worked with having any particularly significant issues with this aspect of the job - certainly not the point of quitting.

I also stand by my objection to the way this issue was expressed by y2k_free_radical. It perpetuates a false and damaging stereotype that women are more "emotional" and less competent than men - which is misogynistic bull****.

 

[Euchromatin]

I have seen this several times,even in good diagnosticians.My comments reflected my experience,not misogyny.I like and respect many women,starting with my wife.

I appreciate your clarification and acknowledge that you may not have intended your prior comment to be misogynistic.
But, whether you think it is or not, claiming that women are "are more emotionally invested than us males" perpetuates false stereotypes, shows your implicit bias and would generally be considering demeaning/degrading in this context as it questions women's fitness to perform this and other intellectually challenging roles.

 

[y2k_free_radical]

I certainly acknowledge that there are varying degrees of confidence in one's diagnostic skills and varying degrees of comfort with uncertainty. We all have colleagues who may get more stains, levels, peer reviews/second opinions, etc. than others. We're also all somewhat limited by our individual anecdotal experiences I suppose, but I am not aware of anyone I have trained or worked with having any particularly significant issues with this aspect of the job - certainly not the point of quitting.

I also stand by my objection to the way this issue was expressed by y2k_free_radical. It perpetuates a false and damaging stereotype that women are more "emotional" and less competent than men - which is misogynistic bull****.

Where did i say "less competent" ? I do think women are more compassionate overall which is a complement.I also think compassionate people are more subject to emotional burnout.

 

[Torsed]

I've found a 5 mm transected ureter in a colectomy specimen. Amongst other surprises.....

Never doubt the fundamental importance of grossing.

What's in your bucket?

 

[yaah]

I have seen fellow pathologists quit practicing because the responsibility for correct diagnosis finally exhausted their emotional reserve.In my experience this is more common with female pathologists.Perhaps it is because they are more emotionally invested than us males.

Most of the unstable and emotionally labile people on this forum are men.

I would not refer to it as emotional reserve exhaustion. Some people just can't handle the stress of being responsible for diagnoses, and being second guessed - which is a big problem in many private groups where so many cases are sent to academic centers for second opinions or continuation of care. Sometimes higher pay or other benefits can outweigh this stress, but sometimes it cannot. Being in a supportive group helps, and some are not lucky enough to have that in their group.

 

[doreegon]

Just chiming in as a PGY1 in a NYS academic program. Residents at my program gross 1 specimen of their choice per day, and gross/sign out every day. We have enough PAs to only gross educational cases and focus on previewing cases and writing reports.

It’s obvious that most programs use residents to not hire PAs, and residents should rank those programs low on the list.

 

[Torsed]

Just chiming in as a PGY1 in a NYS academic program. Residents at my program gross 1 specimen of their choice per day, and gross/sign out every day. We have enough PAs to only gross educational cases and focus on previewing cases and writing reports.

It’s obvious that most programs use residents to not hire PAs, and residents should rank those programs low on the list.

WOW. Don't ever tell anyone you wrote that. Delete it from the earth so attorneys will never find it and throw your hard drive in a frigid lake.

 

[Unty]

Gross one case per day? Lol that’s a weak grossing training program.

 

[ElementMD]

Just chiming in as a PGY1 in a NYS academic program. Residents at my program gross 1 specimen of their choice per day, and gross/sign out every day. We have enough PAs to only gross educational cases and focus on previewing cases and writing reports.

It’s obvious that most programs use residents to not hire PAs, and residents should rank those programs low on the list.

This is very helpful. Thank you.
It is good to see the whole range. From asking around, in NY and other tri-state program this seems to be common. Subspeciality signout grossing a couple of specimens per day.

 

[doreegon]

WOW. Don't ever tell anyone you wrote that. Delete it from the earth so attorneys will never find it and throw your hard drive in a frigid lake.

The program believes that previewing and signing out cases is a better use of our time and frankly I agree. Obviously our cases are tracked to ensure we’ve grossed a wide variety of specimens and junior residents are taught/supervised by the PAs, but our fellows don’t gross, our attendings don’t gross.... what’s the point of forcing residents to gross specimens they already know how to gross?

 

[Torsed]

From someone who owns a path group, albeit smaller, I suggest you gross big complicated specimens as frequently as possible and sign out like a mad man because when your job on the outside of that starts, that will be the game. Everyday, probably with no breaks.

You will constantly have to make up for weaker pathologists (as you likely do in residency), plus gobs of administrative duties.

I also highly recommend you spend as much time in the clinical lab learning, especially blood bank.

The goal is to have these basics down (sign out / grossing) so you can master the rest of the management circus that no one teaches you in residency.

 

[azrael87]

The program believes that previewing and signing out cases is a better use of our time and frankly I agree. Obviously our cases are tracked to ensure we’ve grossed a wide variety of specimens and junior residents are taught/supervised by the PAs, but our fellows don’t gross, our attendings don’t gross.... what’s the point of forcing residents to gross specimens they already know how to gross?

Haven't posted in a while...not sure why this is what I decided to do on my study break . PGY-4 here. I think there's a definite ideal (and likely rare) middle ground here. My program definitely grosses a lot (reactions to the OP's load make me feel pretty competent), arguably on the bad side of the line. However, we do see the slides for most of our big cases. Also, the surg path grossing is weighted to the beginning of residency: 7 months first year, scaling down to 1-2 months of grossing in the first couple months of 4th year - main purpose of those last months being training/supervision of the newbies.

Grossing too much is certainly a detriment with significant diminishing returns, massively so if you don't get to see most of the slides. However, understanding what goes into grossing WELL is important to be able to correlate with what you see on the scope. Being able to read a gross dictation and easily get the full picture can give relevant context. It's also important to making a call on when a specimen needs to be returned to. Sometimes just knowing when to ask for more targeted or thorough sampling seems to be able to save a lot of head-scratching or excessive IHCs (and knowing when not to can create a happier resident/PA environment). If you don't know how to do it really well yourself, it's kinda hard to judge whether what you've been given is any good and how to fix it.

IMHO, one complex specimen a day just isn't enough to get that solid gross-micro correlation, though it doesn't have to be as much as the OPs or my experience. If it's up to you how much you do, consider kicking it up a notch or 2.

 

[ElementMD]

Thank you so much for the feedback.