Is there something wrong with my program?

[PunkRockDoc]

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Hi everyone,

I was just curious how other programs work their autopsy rotation and morgue upkeep. At my program, it was recently instituted into our resident job descriptions that we are responisible for mopping the floors in the morque. I'm not talking about simply cleaning up the blood/mess following a case, but bleaching and scrubbing the entire floor including the areas unaffected by the case. Honestly, I spend a good hour after I complete an autopsy scrubbing and mopping. Does anyone else have such involved stringent clean up responsibilities? We get yelled at by the morgue technicians if they don't think it is up to snuff.

Also, I was wondering how everyone's slides come to them when they are on surgical rotations. Our slides come completely randomly, with cases spread across trays, and not in numerical order. Our paper work is also randomly ordered and often has many spelling errors. A resident at another program told me that this doesn't happen at their program, that their paperwork and slides are organized when they get them, and they simply sit down and preview them. I was just wondering how it is at other programs - is my experience more the exception or the rule?

 

[LADoc00]

Hi everyone,

I was just curious how other programs work their autopsy rotation and morgue upkeep. At my program, it was recently instituted into our resident job descriptions that we are responisible for mopping the floors in the morque. I'm not talking about simply cleaning up the blood/mess following a case, but bleaching and scrubbing the entire floor including the areas unaffected by the case. Honestly, I spend a good hour after I complete an autopsy scrubbing and mopping. Does anyone else have such involved stringent clean up responsibilities? We get yelled at by the morgue technicians if they don't think it is up to snuff.

Also, I was wondering how everyone's slides come to them when they are on surgical rotations. Our slides come completely randomly, with cases spread across trays, and not in numerical order. Our paper work is also randomly ordered and often has many spelling errors. A resident at another program told me that this doesn't happen at their program, that their paperwork and slides are organized when they get them, and they simply sit down and preview them. I was just wondering how it is at other programs - is my experience more the exception or the rule?

No place I have ever been used MDs to perform janitorial duties. In fact, in my current job I clean nothing, literally if coffee spills on my lab coat it is immediately replaced by a waiting technician.

As to receiving unnumbered slides, for what? Autopsies or surgical cases?

If you are getting uncorrelated paperwork and unnumbered slides, your program has issues that extend far beyond simply being substandard and dip into straight up criminal incompetence.

 

[KeratinPearls]

Hi everyone,

I was just curious how other programs work their autopsy rotation and morgue upkeep. At my program, it was recently instituted into our resident job descriptions that we are responisible for mopping the floors in the morque. I'm not talking about simply cleaning up the blood/mess following a case, but bleaching and scrubbing the entire floor including the areas unaffected by the case. Honestly, I spend a good hour after I complete an autopsy scrubbing and mopping. Does anyone else have such involved stringent clean up responsibilities? We get yelled at by the morgue technicians if they don't think it is up to snuff.

Also, I was wondering how everyone's slides come to them when they are on surgical rotations. Our slides come completely randomly, with cases spread across trays, and not in numerical order. Our paper work is also randomly ordered and often has many spelling errors. A resident at another program told me that this doesn't happen at their program, that their paperwork and slides are organized when they get them, and they simply sit down and preview them. I was just wondering how it is at other programs - is my experience more the exception or the rule?

You shouldn't be mopping the floor in the areas unaffected by the case. That is what janitors are for. You are not a janitor, you are a physician. I would take it up to the chairman or PD. That is totally unnecessary work you are doing.

At my program, I clean up my mess and leave the trays for the "mortality specialists" to clean. If there is blood on the ground, I am considerate and wipe up my mess. If there are guts and fat on the trays I throw them away. If there is blood I wash it off. I don't do any scrubbing, just rinsing. We have ppl clean the trays.

To have morgue technicians yell at you for not cleaning up a mess you did not make is ridiculous. I think you need to be treated with more respect than that.

The requisition forms for the cases we grossed the day before come to us in no particular order and are placed at our desks. The slides come later organized by case in slide folders. The slides don't come out randomly and mixed with other cases (so that we would have to sort the slides out, according to case number), like a deck of cards, if that is what you are asking.

 

[yaah]

I've actually heard about programs that just give residents random slides and expect them to collate them. Pretty weak.

As far as cleanup, I dunno, maybe they're hazing you? I have never heard of residents being forced to do someone else's job. A lot of residents will help clean up in some fashion, but being forced to do it?

I agree though this all sounds like incompetence on the program's behalf. It needs to stop. If the program director won't do it, go to the GME office. If the program doesn't like you doing that, it isn't your fault.

 

[veo1]

I've actually heard about programs that just give residents random slides and expect them to collate them. Pretty weak.

As far as cleanup, I dunno, maybe they're hazing you? I have never heard of residents being forced to do someone else's job. A lot of residents will help clean up in some fashion, but being forced to do it?

I agree though this all sounds like incompetence on the program's behalf. It needs to stop. If the program director won't do it, go to the GME office. If the program doesn't like you doing that, it isn't your fault.

We collate slides at my institution.....a so called "big name" program. On our preview days, a good chunk of the day is spent editing gross descriptions that transcriptionists mess up, running back and forth to the histo lab to locate missing slides/blocks/paperwork, and we have to match up all of the paperwork with our slides. We're lucky if we start previewing by 5pm. Sucks

 

[mlw03]

i'll give OSU props so far in this regard. no silly scut. i clean my own messes in the gross and autopsy areas; no more, no less. histology and transcription do a solid job getting slides to us in a reasonably timely manner, with slides and documents in the same order. if transcriptionists can't understand a word, they leave it blank and we can just go into the computer ourselves to edit it, but this only seems to have about once a week. i don't dictate punctuation most of the time, and they manage to get it right. when i'm at work, it's doing stuff that pathologists should be doing, not stuff the department wants done cheaply. i think these types of issues matter far more in program selection than most applicants think about, so i encourage program applicants to ask these types of logistical questions when you talk to residents on interview trips. know what you're getting yourself into on a day-to-day basis, and decide what your priorities are.

so back to the original poster, no, i don't think your experience is the rule. it's an unpleasant exception. i would talk to the chief residents, and strongly consider bringing it to the AP director and/or program director. what you describe with the stuff being out of order is a recipe for an identification error.

 

[sohsie]

Im curious which of the 6 ACGME core competencies mopping the floors falls under: Patient Care, Medical Knowledge, Practice Based Learning, Interpersonal and Communication Skills, Professionalism, or Systems Based Practice?

Seriously, if its in writing, I would save a copy, then go to the GME office at your institution and explain that you would be happy to forward the job description to the ACGME if this situation is not resolved. Of course, you may just want to do it anonymously (Send a letter) since Im sure a program that would do something stupid like that would have no problem retaliating against any whistle blower.

I wouldnt be surprised if the morgue techs decided that they didnt feel like mopping the floors anymore, and the department gave in because they didnt want to cross the union. In that case, you have to show that they dont want to cross you either. They can hire janitors for that.

Hi everyone,

I was just curious how other programs work their autopsy rotation and morgue upkeep. At my program, it was recently instituted into our resident job descriptions that we are responisible for mopping the floors in the morque. I'm not talking about simply cleaning up the blood/mess following a case, but bleaching and scrubbing the entire floor including the areas unaffected by the case. Honestly, I spend a good hour after I complete an autopsy scrubbing and mopping. Does anyone else have such involved stringent clean up responsibilities? We get yelled at by the morgue technicians if they don't think it is up to snuff.

Also, I was wondering how everyone's slides come to them when they are on surgical rotations. Our slides come completely randomly, with cases spread across trays, and not in numerical order. Our paper work is also randomly ordered and often has many spelling errors. A resident at another program told me that this doesn't happen at their program, that their paperwork and slides are organized when they get them, and they simply sit down and preview them. I was just wondering how it is at other programs - is my experience more the exception or the rule?

 

[Napoleon1801]

Hi everyone,

I was just curious how other programs work their autopsy rotation and morgue upkeep. At my program, it was recently instituted into our resident job descriptions that we are responisible for mopping the floors in the morque. I'm not talking about simply cleaning up the blood/mess following a case, but bleaching and scrubbing the entire floor including the areas unaffected by the case. Honestly, I spend a good hour after I complete an autopsy scrubbing and mopping. Does anyone else have such involved stringent clean up responsibilities? We get yelled at by the morgue technicians if they don't think it is up to snuff.

Also, I was wondering how everyone's slides come to them when they are on surgical rotations. Our slides come completely randomly, with cases spread across trays, and not in numerical order. Our paper work is also randomly ordered and often has many spelling errors. A resident at another program told me that this doesn't happen at their program, that their paperwork and slides are organized when they get them, and they simply sit down and preview them. I was just wondering how it is at other programs - is my experience more the exception or the rule?

The pathology version of boot camp perhaps?

 

[LADoc00]

Yaah brought up a valuable point, they could be intentionally hazing you...

what program is this??

sounds interesting, now have they made you stand on top of the hospital with concrete block tied to rope and attached to your shlong?

Have you been forced to streak the quad? or even the doctor dining room at the lunch rush?

 

[deschutes]

I wouldnt be surprised if the morgue techs decided that they didnt feel like mopping the floors anymore, and the department gave in because they didnt want to cross the union. In that case, you have to show that they dont want to cross you either. They can hire janitors for that.

I could totally see that happening. And I agree, if all else fails, go to the ACGME - that's what they are there for. Not sure how ACGME is funded, but if it's tax dollars, then I'd be more than happy to know that my tax dollars were going towards protecting physicians-in-training from janitorial duties.

 

[PunkRockDoc]

Thanks for your replies everyone. As the slides go, we get them uncollated and spend a lot of time organizing them. That's not really a big deal, but a friend at another program seemed pretty surprised that we had to collate our own slides, so I thought that I would see what the consensus was.

The morgue thing, however, I feel is rediculous. It's not hazing - senior residents are subject to this as well. In fact, if we get yelled at, the chiefs get yelled at as well that they are not training us properly. They now want us to clean out the drains in the sinks and the autopsy table as well. As for having it in writing, we don't quite have it yet. It was apparently written in an internal memo from the laboratory director that was distributed to the attendings. The reason we found out about was because one of our autopsy attendings thought it was a rediculous requirement and he showed us the email and asked us our opinon of it. We have brought it up with our program director and the head of AP, and they essentially told us it was like this at other places and that we were just lazy complainers (but in more eloquent terms). I think a lot of this came about when our morgue supervisor retired a few months ago and the bean counters, in all their wisdom, dissolve the morgue director position and divided up the work between some techs and the residents.

Since I've opened up this discussion, I would like to get some perspective on a few more areas:

1. Clinical path rotations - how do you spend you time? We literally spend the majority of the day typing reports and making tiny grammatical changes at our attendings' whim (like changing "...is suggestive of..." to "...suggestive of...". This involves going to the lab to obtain a new printout of the data, and then using a microsoft word template to print our diagnosis onto the sheet that has the data.

2. Does anyone have a relatively updated library of books to use in their resident's room? We have a library of books averaging 15 years old (a copy of the latest Rosai is the newest thing that we have). The program is refusing to buy new books for our library because they believe that they will be stolen (no recent history of this happening). They recently purchased a new copy of Potter's Pediatric Pathology for us, which is kept under lock and key in an attendings office, and is essentially only available to us from 9-5.

3. How many programs have a weekly unknown conference and/or a QA/QC conference? We have been trying to start an unknown conference for the last year, and the attendings refuse to participate. We started our own resident run conference. Bear in mind that we always wanted this conference to be resident run and organized, but we wanted an attending to sit in to make sure that we don't mistakenly teach each other incorrect information. The attendings have their own daily conference where they review difficult cases, but we are not allowed to attend this conference.

Any perspective would be appreciated. These are things that seemed pretty standard to many programs when I interviewed in '07, but then again I thought my program had such things when I interviewed here as well.

 

[sohsie]

Thanks for your replies everyone. As the slides go, we get them uncollated and spend a lot of time organizing them. That's not really a big deal, but a friend at another program seemed pretty surprised that we had to collate our own slides, so I thought that I would see what the consensus was.

The morgue thing, however, I feel is rediculous. It's not hazing - senior residents are subject to this as well. In fact, if we get yelled at, the chiefs get yelled at as well that they are not training us properly. They now want us to clean out the drains in the sinks and the autopsy table as well. As for having it in writing, we don't quite have it yet. It was apparently written in an internal memo from the laboratory director that was distributed to the attendings. The reason we found out about was because one of our autopsy attendings thought it was a rediculous requirement and he showed us the email and asked us our opinon of it. We have brought it up with our program director and the head of AP, and they essentially told us it was like this at other places and that we were just lazy complainers (but in more eloquent terms). I think a lot of this came about when our morgue supervisor retired a few months ago and the bean counters, in all their wisdom, dissolve the morgue director position and divided up the work between some techs and the residents.

Since I've opened up this discussion, I would like to get some perspective on a few more areas:

1. Clinical path rotations - how do you spend you time? We literally spend the majority of the day typing reports and making tiny grammatical changes at our attendings' whim (like changing "...is suggestive of..." to "...suggestive of...". This involves going to the lab to obtain a new printout of the data, and then using a microsoft word template to print our diagnosis onto the sheet that has the data.

2. Does anyone have a relatively updated library of books to use in their resident's room? We have a library of books averaging 15 years old (a copy of the latest Rosai is the newest thing that we have). The program is refusing to buy new books for our library because they believe that they will be stolen (no recent history of this happening). They recently purchased a new copy of Potter's Pediatric Pathology for us, which is kept under lock and key in an attendings office, and is essentially only available to us from 9-5.

3. How many programs have a weekly unknown conference and/or a QA/QC conference? We have been trying to start an unknown conference for the last year, and the attendings refuse to participate. We started our own resident run conference. Bear in mind that we always wanted this conference to be resident run and organized, but we wanted an attending to sit in to make sure that we don't mistakenly teach each other incorrect information. The attendings have their own daily conference where they review difficult cases, but we are not allowed to attend this conference.

Any perspective would be appreciated. These are things that seemed pretty standard to many programs when I interviewed in '07, but then again I thought my program had such things when I interviewed here as well.

The slides thing, Ive encountered that before, so not much you can do there. It sucks, but you'll get pretty quick at it as you go along.

As for the autopsy detail, you need to band the residents together and put a stop to that. No other program that I know of would even think of doing that. I would do the following:

1) Call/meet residents or attendings in other programs in your area and make sure they aren't doing janitorial duty in the autopsy suite. You will need this to counter their absurd notion that everyone else does it.

2) Get all of the residents on board to protest this as one group (or as many as you can)

3) Go to the program director and tell them that you arent janitors. Tell them that you investigated all the programs in your area and none of them are doing this. If they persist in this lie, tell them to name a program and that you will follow up on it and see if it is true. Tell them that you will go to the GME office in your hospital and if that doesnt work, you will report this to the ACGME. I would make sure that everyone takes turns speaking so the program doesn't single out one person as the "ringleader"

4) Follow through on the GME and the ACGME part in 3 doesnt work. Checking with all of the other programs will also help with the GME office, who may have no clue what goes on in other programs.

As for educational conferences, books and such, the ACGME RRC for pathology guidelines are quite clear that these types of conferences must be taking place and that you have to have adequate resources as well. Check the ACGME websites for details on this. You may want to throw that into the autopsy protest as well.

Seriously, dont waste your life mopping and cleaning. Thats not what your MD is for.

 

[yaah]

Regardless of whether other programs are doing it or not, it should not be your job to swab the deck and unclog drains. If their rationale for making you do it is that "other programs do it" that is basically irrelevant. But as sohsie said if you do take the extra step and call other programs it will perhaps be more effective and embarrassing for them.

Agree about educational conferences - it's great that you are trying to start them on your own. Do you have "friendly" attendings that might be willing to help you out with these?

The CP paperwork thing I don't know what to think about. A lot of CP is automated or verified by techs anyway, so that wouldn't apply.

As for new books, that's also weak. I don't know if there are specific ACGME regulations in regards to updated libraries, but I suspect there is something there. Programs are supposed to have funds for resident education. If the books get stolen, I can understand that being a problem, but the solution is not to stop buying books or make them inaccessible. The solution is to give more "ownership" of it to the residents or the chief resident.

You're not allowed to attend the daily attending QA/QC conference? That's also rather weak.

 

[beary]

Regardless of whether other programs are doing it or not, it should not be your job to swab the deck and unclog drains. If their rationale for making you do it is that "other programs do it" that is basically irrelevant. But as sohsie said if you do take the extra step and call other programs it will perhaps be more effective and embarrassing for them.

Totally agreed. I know it is very hard to go out on a limb but it is BS that you are being treated this way.

 

[pathstudent]

Thanks for your replies everyone. As the slides go, we get them uncollated and spend a lot of time organizing them. That's not really a big deal, but a friend at another program seemed pretty surprised that we had to collate our own slides, so I thought that I would see what the consensus was.

The morgue thing, however, I feel is rediculous. It's not hazing - senior residents are subject to this as well. In fact, if we get yelled at, the chiefs get yelled at as well that they are not training us properly. They now want us to clean out the drains in the sinks and the autopsy table as well. As for having it in writing, we don't quite have it yet. It was apparently written in an internal memo from the laboratory director that was distributed to the attendings. The reason we found out about was because one of our autopsy attendings thought it was a rediculous requirement and he showed us the email and asked us our opinon of it. We have brought it up with our program director and the head of AP, and they essentially told us it was like this at other places and that we were just lazy complainers (but in more eloquent terms). I think a lot of this came about when our morgue supervisor retired a few months ago and the bean counters, in all their wisdom, dissolve the morgue director position and divided up the work between some techs and the residents.

Since I've opened up this discussion, I would like to get some perspective on a few more areas:

1. Clinical path rotations - how do you spend you time? We literally spend the majority of the day typing reports and making tiny grammatical changes at our attendings' whim (like changing "...is suggestive of..." to "...suggestive of...". This involves going to the lab to obtain a new printout of the data, and then using a microsoft word template to print our diagnosis onto the sheet that has the data.

2. Does anyone have a relatively updated library of books to use in their resident's room? We have a library of books averaging 15 years old (a copy of the latest Rosai is the newest thing that we have). The program is refusing to buy new books for our library because they believe that they will be stolen (no recent history of this happening). They recently purchased a new copy of Potter's Pediatric Pathology for us, which is kept under lock and key in an attendings office, and is essentially only available to us from 9-5.

3. How many programs have a weekly unknown conference and/or a QA/QC conference? We have been trying to start an unknown conference for the last year, and the attendings refuse to participate. We started our own resident run conference. Bear in mind that we always wanted this conference to be resident run and organized, but we wanted an attending to sit in to make sure that we don't mistakenly teach each other incorrect information. The attendings have their own daily conference where they review difficult cases, but we are not allowed to attend this conference.

Any perspective would be appreciated. These are things that seemed pretty standard to many programs when I interviewed in '07, but then again I thought my program had such things when I interviewed here as well.

C'mon you got to tell us what program you are at...that is some of the funniest stuff I have read in my life.

Mopping floors is definitely not punk rock. Don't do it.

 

[earmuff]

😱 F'd up program. I thought mine was bad. You win.

 

[dropout]

Thanks for your replies everyone. As the slides go, we get them uncollated and spend a lot of time organizing them. That's not really a big deal, but a friend at another program seemed pretty surprised that we had to collate our own slides, so I thought that I would see what the consensus was.

The morgue thing, however, I feel is rediculous. It's not hazing - senior residents are subject to this as well. In fact, if we get yelled at, the chiefs get yelled at as well that they are not training us properly. They now want us to clean out the drains in the sinks and the autopsy table as well. As for having it in writing, we don't quite have it yet. It was apparently written in an internal memo from the laboratory director that was distributed to the attendings. The reason we found out about was because one of our autopsy attendings thought it was a rediculous requirement and he showed us the email and asked us our opinon of it. We have brought it up with our program director and the head of AP, and they essentially told us it was like this at other places and that we were just lazy complainers (but in more eloquent terms). I think a lot of this came about when our morgue supervisor retired a few months ago and the bean counters, in all their wisdom, dissolve the morgue director position and divided up the work between some techs and the residents.

Since I've opened up this discussion, I would like to get some perspective on a few more areas:

1. Clinical path rotations - how do you spend you time? We literally spend the majority of the day typing reports and making tiny grammatical changes at our attendings' whim (like changing "...is suggestive of..." to "...suggestive of...". This involves going to the lab to obtain a new printout of the data, and then using a microsoft word template to print our diagnosis onto the sheet that has the data.

2. Does anyone have a relatively updated library of books to use in their resident's room? We have a library of books averaging 15 years old (a copy of the latest Rosai is the newest thing that we have). The program is refusing to buy new books for our library because they believe that they will be stolen (no recent history of this happening). They recently purchased a new copy of Potter's Pediatric Pathology for us, which is kept under lock and key in an attendings office, and is essentially only available to us from 9-5.

3. How many programs have a weekly unknown conference and/or a QA/QC conference? We have been trying to start an unknown conference for the last year, and the attendings refuse to participate. We started our own resident run conference. Bear in mind that we always wanted this conference to be resident run and organized, but we wanted an attending to sit in to make sure that we don't mistakenly teach each other incorrect information. The attendings have their own daily conference where they review difficult cases, but we are not allowed to attend this conference.

Any perspective would be appreciated. These are things that seemed pretty standard to many programs when I interviewed in '07, but then again I thought my program had such things when I interviewed here as well.

I feel for you.

I just want you to be careful on how you approach your department on this issue. I'm reminded of surgical residents who complained about violations of the 80hr work week. they probably were able to enact change, but also may have been punished by not seeing the inside of an OR for 6 months.

Anyone have suggestions on how s/he can get this ridiculous situation resolved without putting a career in jeopardy? My first thought is perhaps getting graduating chiefs on board.

 

[yaah]

It's not going to put your career in jeopardy if it's a valid complaint. That's grounds for a massive lawsuit. It might be uncomfortable, but it's probably necessary. And going to GME can be done in an anonymous fashion - violations like this are not really identifiable as to source, since they apply to the whole program.

 

[PunkRockDoc]

Again everyone, thanks for all of your input. It is nice to know that other programs out there do not have these problems, and that our attendings claim that "it's like this everywhere" is unfounded. All of the residents here have been talking about going to the GME, but we are a bit worried about the potential fallout. There is a bit of a silver lining, though. We had a new chairperson start this month, and he seems like he will be a proponent of change for the better. It is interesting, though, how quickly our program slumped to the state that it is now in following the exit of our former chair (about 18 months).

However, I would like to get opinions on a few more issues, if everyone would be so kind:

1. How much elective time do most programs get? One of the reasons that I came to this program was because they offered 6 months of elective time. These electives can be taken at outside institutions. This was important to me because I'm interested in forensics, and want to do electives in forensics and pediatric pathology (we see zero peds here now, since they closed our children's hospital and we do not have an organized peds rotation). However, because of budget cutbacks, the PA at one of our sister hospitals was laid off and now we have to cover that hospital as a surgical path rotation for four months. To even out the schedule, they took away two of our elective months, one of our blood bank months, and one of our autopsy months. To add insult to injury, we do not yet have an official description of this new rotation nor a letter of agreement with the hospital to make it official.

2. Our hospital no longer has a dermatologist, and one of the big plastic surgeons left. So we have minimal dermpath. We did have an excellent adjunct dermpath attending who would come and lecture and review unknown slides for two 90 minute sessions per month. However, that attending has since been let go, and our dermpath lectures are now 60 min about every 3 months. How much dermpath do other people get exposure to?

I know that everyone has been asking me which program I am at. The reason I have not mentioned which program is that my fellow residents have asked me not to do so, out of concern that their reputation might be tarnished once they head out to fellowship. Besides, I think that there are enough clues within my posts and my profile for the inquiring mind to decipher.

 

[ABC789]

Have you considered transferring to a different program??