Is PGY-1 pathology supposed to be this hard?

[danli77]

I am on surgicals ... and to say the least did not expect pathology to be this tough and malignant at all.....

I am not sure how it is at other programs, but I am very disappointed with my choice of specialty at this point... is it not normal to feel this way during first few months or am I going crazy?

😱😱😱

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[KeratinPearls]

I am on surgicals ... and to say the least did not expect pathology to be this tough and malignant at all.....

I am not sure how it is at other programs, but I am very disappointed with my choice of specialty at this point... is it not normal to feel this way during first few months or am I going crazy?

😱😱😱

Yes it is difficult even more so if you are at a high volume institution. The difficulty lies in triaging cases, learning how to gross while at the same time learning how to diagnose. Managing your time is very important. Don't hold onto cases. If you don't know a diagnosis, enter a diagnosis and signout with the attending.

It is important to ask for help if you don't know how to do something. You can make huge errors if you ASSume something. You have to learn things very quickly and yes, I know it's hard because there is so much to learn. Things will get better as you go on in residency as you will then know how to gross and diagnose without assistance and do things efficiently.

Life sucked for me as a first year. I learned by struggling and I am much more efficient now. Attendings will be upset because some will have little patience. If you screw something up big time, that is an easy way to get on anyone's sh*tlist. That's why its important to ask for help if you dont know. Also it helps if you have a good surgpath fellow or helpful senior residents. Some places the resident camaraderie is nonexistent, so that's why picking a program where you feel comfortable is important (for all those applying). I think as a first year, you have to make sure you gross your specimens correctly, do things on time and do whatever your attending tells you to do and you will be fine.

I've seen residents cry because they were so overwhelmed. So, you are not alone. I think I developed fibromyalgia from all the stress first year. I always thought to myself "Hey at least Im not in internal medicine or surgery." That made me feel a lot better. Plus, I got to sleep 6-7 hours a night.

 

[danli77]

Yes it is difficult even more so if you are at a high volume institution. The difficulty lies in triaging cases, learning how to gross while at the same time learning how to diagnose. Managing your time is very important. Don't hold onto cases. If you don't know a diagnosis, enter a diagnosis and signout with the attending.

It is important to ask for help if you don't know how to do something. You can make huge errors if you ASSume something. You have to learn things very quickly and yes, I know it's hard because there is so much to learn. Things will get better as you go on in residency as you will then know how to gross and diagnose without assistance and do things efficiently.

Life sucked for me as a first year. I learned by struggling and I am much more efficient now. Attendings will be upset because some will have little patience. If you screw something up big time, that is an easy way to get on anyone's sh*tlist. That's why its important to ask for help if you dont know. Also it helps if you have a good surgpath fellow or helpful senior residents. Some places the resident camaraderie is nonexistent, so that's why picking a program where you feel comfortable is important (for all those applying). I think as a first year, you have to make sure you gross your specimens correctly, do things on time and do whatever your attending tells you to do and you will be fine.

I've seen residents cry because they were so overwhelmed. So, you are not alone. I think I developed fibromyalgia from all the stress first year. I always thought to myself "Hey at least Im not in internal medicine or surgery." That made me feel a lot better. Plus, I got to sleep 6-7 hours a night.

Hahaha.... thank you for your post! I love the last paragraph, I always said "well at least pathology won't be as bad as surgery and IM and people will be nicer". To tell you the truth I did not expect to find so many malignant people in a pathology department. I think this was my biggest disappointment.

Grossing.... Oh yes! Worst days of my life... I can say with a 100% certainty... You are right it is important to gross specimens correctly.... BUT.... it is very easy to screw up a specimen, especially something like a very sloppy pharyngectomy (on the surgeon's part)...
I don't think grossing is easy by any means, it is a skill, and no matter what specimen it is as a first year you end up asking anyone and everyone "how do I gross this fibroid uterus?".....

And the anticipation of a "painful" sign-ou session after that grossing day is even MORE painful lol.

Anyhow at least I am not alone feeling like a total looser that is ready to throw in the towel.....

 

[KeratinPearls]

If you have naturally malignant attendings in your program then you are in a tough position. I've come to realize that malignant ppl are those that are just unhappy with their own lives or they are just plain psychotic (believe me I worked with one). Most pathologists I have met have all been fair and nice (some of course are weird).

For those applying, I would seek out programs like this and avoid them. Four years is a long time and you dont want to be miserable throughout your residency.

 

[pathstudent]

Don't worry you'll get through it. It is a transition. A lot of people find it bumpy at first

Not assuming this applies to you but Part of the problem is that upper middle class kids that go to medical school in this day and age have never had a real job before residency. They have never had to do some demeaning task for **** pay. When I was a resident I can remember a handful that said their first paycheck in residency was their first paycheck ever. That can make it a tough transition too.

 

[cjw0918]

Danli, first year is HARD. Remember you didn't spend the last two years in med school doing this stuff. You were rounding, seeing pts in clinic, admitting from the ER, and doing other clinical medicine tasks. Path residency is like starting over completely in many ways.

True story: My first day of path residency, I did not know what it meant to "gross.' Seriously. My only exposure to path had been in a private group where PAs did all grossing. I had no idea that residents spent all this time "grossing", believe it or not!

But every year as a resident I enjoyed my time and learning more. As for surly attendings, just try to find something to learn from them, even if it's the mere experience of dealing with a sadist. You will be well-served to approach everyone with their various personality traits/disorders as a "learning experience."

Good luck to you and hang in there. It will get better.

 

[KCShaw]

Also depends a bit on what you really mean by "this tough and malignant". Everyone's definition/perception of that may be different. On the one hand, yeah, it's pretty much always going to be a culture shock and PGY1's tend to find themselves starting over in ways those in other specialties don't have to. But sometimes people find out the hard way that they didn't really know what they were getting into, and the more they find out, the less they want to stay. It happens. I suspect it's the most common reason pathology residents quit to do something else, locally malignant attendings/programs notwithstanding.

But I've seen PGY1's who turned into good, knowledgeable, confident seniors/chiefs cry early on while working through that transition period. Not most of them, but some, sure.

They can only take from you what you give them.

 

[2121115]

Keep your head down, mind your own business, and work hard. The three keys to making it through residency. Before you know it you'll be an attending yourself.

 

[Arctic Char]

Keep your head down, mind your own business, and work hard. The three keys to making it through residency. Before you know it you'll be an attending yourself.

and you'll start scrutinizing details you previously rolled your eyes at.

 

[pathgrrl]

I feel you! My first two years felt like that uncomfortable spot between a rock and a hard place. I wanted to quit but when i talked to my friends at other institutions it was the same for them.
On surgical pathology, ask, ask, ask questions. Have your grossing manual (Lester) ready and use dictation templates when you can. When you get feedback (constructive or malignant) just say OK, I'll know for next time. Do more than expected of you (volunteer to open that colon for your senior resident). Eventually your colleagues will see you as a team player and things will get easier.
However - do not violate duty hours! They are there for your safety and for the safety of the patients.

 

[Ishie1013]

I cried a lot during my first year and felt generally useless despite being at a program where my superiors are made out of unicorn kisses. I felt stupid constantly, injured myself early on, and felt overwhelmed.

It gets way better.

Things start to make sense. Once they do, the rest of it falls into line, as in, once you start to really understand endometrial cancer, you understand better how to gross a specimen suspicious for it, because you know what you want to see.

As stated, ask ask ask ask. I got dinged initially for being quiet and never asking questions because your third and fourth year of medical school, you're conditioned not to bug the attendings.

Dictation templates are awesome. Don't get too reliant on them, but I found myself getting tongue tied by things as simple as "What color is the mucosa", and they help establish a rhythm.

When it doubt, weigh it.

Colons: Lymph node solution is your friend. Those epiploic appendages are not going to yield nodes no matter how much you want them to.

Malignancy may be relative. The attending I was the most afraid of at first is also the one most likely to tell off the surgeons for yelling at us.

Deep breaths and if needed, slow down. Taking my time on frozens is what got me to stop knocking them off the chuck because I was rushed, which takes way more time than doing them correctly.

Talk to your fellow residents. When I felt like the lonely screw up of surge path, we had a couple first year brunches which consisted of everyone bursting out "I feel stupid!!!"

 

[Cica]

I

Dictation templates are awesome. Don't get too reliant on them, but I found myself getting tongue tied by things as simple as "What color is the mucosa", and they help establish a rhythm.

"

Hey where can i get hold of dictation templates? Thanks

 

[mlw03]

Hey where can i get hold of dictation templates? Thanks

Most departments generate their own internally, based on what specific things the pathologists want noted for a given type of specimen. Generic ones are available for most major specimen types in the Lester grossing manual.

 

[Cica]

Thanks.🙂

 

[yaah]

Don't forget to ask for help.

Learning anything new can be daunting, especially if you have poor or vague instruction. This is often not intentional, people who do pathology and are experienced at it often have a very poor recollection of what it was like to be new.

The worst thing you can do is mess up a specimen and harm a patient because you were too afraid to ask for help or admit you were wrong. Anyone who gets on you for this or "punishes you" for this is wrong and should be called on it.

The other thing is to not try to learn everything at once. Residency is a long time. Knowledge will come with time. Focus on what you have to learn right away, the rest will come if you let it. But always be looking to further your knowledge base and don't wait for people to tell you what to do and what to learn.

 

[KeratinPearls]

The other thing is to not try to learn everything at once. Residency is a long time. Knowledge will come with time. Focus on what you have to learn right away, the rest will come if you let it. But always be looking to further your knowledge base and don't wait for people to tell you what to do and what to learn.

Agree with this. You can get overwhelmed if you let it. You will learn things with time. Read about your cases because those are the cases you will see in practice. Get an outline book like the Diagnostic Foundation series. Those books highlight the most important things you should know about an entity.