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[NoPts]

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Hi everyone. I am a long-time reader, first-time poster. I am a 4th year med student, and am almost certain I will be a pathologist when I grow up. I was wondering if anybody has any strong opinions about the university of minnesota's program. Also, what is mayo's reputation for pathology? Are their applicants as competitive as one would expect, Step 1 scores 240+ ?

Thanks!

 

[schrute]

Hi everyone. I am a long-time reader, first-time poster. I am a 4th year med student, and am almost certain I will be a pathologist when I grow up. I was wondering if anybody has any strong opinions about the university of minnesota's program. Also, what is mayo's reputation for pathology? Are their applicants as competitive as one would expect, Step 1 scores 240+ ?

Thanks!

There's a handful of posts in the log discussing U of M and Mayo--I'd check those out for a historic (recent history) perspective from apps & residents.

Speaking from someone who interviewed at both but didn't end up there, U of M seemed like an avg mid-tier program (not to plagiarize deschutes): the interview was screwey (Sat w/~15 candidates) and the dept / facilities were virtually a ghost town. Their numbers seem good but the work is spread out over a few different hospitals in MLPS; plenty of fellowships; residents seemed somewhat happy, I just wasn't as impressed with the program as a whole. Teaching / preview time / signout seemed to vary alot bet the different hospitals.

Mayo is Mayo. You do things the Mayo way, you have the Mayo name (insane volume, plenty of cases...you'll see everything 10 times over), and if you want to stay in the area for fellowship or practice (they have every fellowship available I think), word of mouth will help tremendously.
Some services are insanely busy (surg path) and teaching is +/- depending on the service; frozens are unique at Mayo compared to every other program in the country. Your best bet is to search the old threads for Mayo evals.
Bottom line: don't take anyone else's word for how fantastic or crappy a program is (especially Mayo: people seem to either love it or hate it). Just apply and find out for yourself.

I dunno about the 240+ USMLE...I had no where near that and still interviewed there (no idea if I was even ranked though...I matched at my #1 so didn't fall to Mayo on my list).

 

[deschutes]

Yes, schrute has hit on the highlights in a nutshell. I'll write about UMN more in the UMN thread.

I interviewed for a fellowship at Mayo, so I can perhaps add my 2 cents. If I'm not mistaken, there are people from Mayo on this board so perhaps they can chip in, or correct me if I'm wrong.

Mayo has ties all over the Midwest, if not the rest of the country, which is key when it comes to looking for jobs. They get calls all the time from groups looking to hire.

They're not afraid to spend money to make money - I believe each consultant (attending) has their own secretary, which makes the place incredibly efficient. Everyone has their specific role. Doctors are addressed as "Dr. So-and-so" at all times. Scut is kept at a minimum, because of support staff doing everything they're supposed to do (I don't know who cuts frozens after-hours though). They have great PR (see stickyshift's post on Mayo consultations). I think they have a service desk at the Rochester airport to assist patients. That's the kind of place it is.

You'll work hard - you won't be in the position of wishing you had worked harder. (I'm told of someone who went there for surg path fellowship, didn't bother studying for AP boards and passed.) You'll see tons of material. You'll be a superstar at frozen sections. I've never tried diagnosing prostate cancer on frozen till I interviewed at Mayo. It is a well-oiled machine - imagine an appendectomy, signed out within an hour of the specimen arriving in the gross room. Autopsies are done FS-style too.

The consultants work hard too. Apparently there is a reverse hierarchy at Mayo - the resident leaves first, followed by the fellow, followed by the consultant.

Oh, and you do see regular H&E material. On the "sink"/general surg path rotation, the second day consists of looking at the H&E confirmation slides on the frozen cases from the previous day. Also if I'm not mistaken, residents get elective months on the surg path subspecialty services where they see all kinds of consult material.

They have a bunch of fellowships. Surg path/subspec fellowships include general SP, GI/liver, pulmonary, cardiovascular, neuro.
http://www.mayo.edu/msgme/labmed-programs.html
I think they have dermpath, which for some reason is not listed. No GU/Gyn/H&N, unless those are unlisted as well.

They take education and their reputation very seriously - at the last USCAP I saw a fellowship director single-handedly carrying material to staff their booth for the fellowship fair. I almost couldn't believe the job wasn't being foisted on a secretary or resident.
If they're not tremendously competitive, it probably is because of location (mention Mayo and people immediately start talking about how cold it is and how they could never live there etc.).

 

[yaah]

Dermpath is not listed because it's run out of the dermatology department. They have at least 3 spots per year.

 

[Arctic Char]

just curious here . . . is the title of this thread a play on "marsha marsha marsha!"???

 

[schrute]

I thought it was "Tora! Tora! Tora!"
...it did win an Oscar...

 

[raspberry009]

Hey guys, I am currently a resident at Mayo. I absolutely love it and really feel that made an excellent choice. The learning opportunities are fabulous. One of these days I will have time to post just what all goes on here, just dont have the time currently. But if you need any question answered just let me know.

 

[EUA]

just curious here . . . is the title of this thread a play on "marsha marsha marsha!"???

Dunno, but my first thought was "mustard mustard mustard"!

 

[raspberry009]

Things that make Mayo unique:

The frozen section lab:

Almost all of the specimens are frozen with T. blue. Why T. blue? it takes less than 1 minute (30 sec if your in a hurry)to cut and stain the specimen whereas it typically takes over 3 minutes for H and E. The folowing day everything that was frozen the day before gets processed with H and E, stains...ect. Anything that requires stains for a definitive diagnosis that could not be signed out at the frozen section are labeled "hold over" and those slides hopefully get released the following morning. On your filing day, the morning is split between reviewing hold overs which are often very difficult cases and MC3 (which are slides sent here from outside institutions all over the US). The afternoon is spent reviewing the H and E version of files from the frozen section that have already been signed out.

To be continued...

 

[sohsie]

Ill be the contrarian here.

Disclaimer: Ive never been to Mayo. Everything that I have heard about it is second or third hand.

I think the idea of freezing the majority of your cases, especially in a teaching hospital, is wrong. I think that the best way to learn pathology is to have a stack of cases and go through them on your own before knowing what the diagnosis is. I just don't see how that is done in the Mayo setup. If everything gets a frozen read, then you don't have any preview time. Once there is a prelim diagnosis, then your preview is just not the same, since you are already biased by the prelim. Also, the quality of the slides cannot be as good as paraffin sections. Also, Ive seen frozens stained by T blue. They are not nearly as good as H&E IMHO.

Also, I don't know if this is the case now, but other told me that a great deal of the residents time was spent cutting frozens and not doing something educationally related.

It seems that Mayo is valuing speed/turnaround time over quality patient care (turnaround time is not the only marker of quality patient care, and I just don't believe that the quality of the sections at Mayo can be as good as a paraffin H&E done correctly) and resident education.

 

[yaah]

Well, the end result is that mayo residents come out of training and become good pathologists.

But that being said, I spent time there, I didn't like it. You do see lots of biopsies and outside stuff not done on frozen, so it isn't like you never preview or see cases that aren't already diagnosed. Personally I think the frozen diagnosis way of doing every case leaves something to be desired, but it works for them. You have to have a high volume and lots of dedicated staff though. The frozen procedure is different from traditional frozens - it isn't just the stain, it's the section thickness, the freezing method, and other things. But I agree that resident education is a bit marginalized at the expense of turnaround time. So you definitely want to know what you are getting into before you decide to do residency there - for many people it's a great setup though, it just isn't like a lot of other places.

 

[path28]

Ill be the contrarian here.

Disclaimer: Ive never been to Mayo. Everything that I have heard about it is second or third hand.

I think the idea of freezing the majority of your cases, especially in a teaching hospital, is wrong. I think that the best way to learn pathology is to have a stack of cases and go through them on your own before knowing what the diagnosis is. I just don't see how that is done in the Mayo setup. If everything gets a frozen read, then you don't have any preview time. Once there is a prelim diagnosis, then your preview is just not the same, since you are already biased by the prelim. Also, the quality of the slides cannot be as good as paraffin sections. Also, Ive seen frozens stained by T blue. They are not nearly as good as H&E IMHO.

Also, I don't know if this is the case now, but other told me that a great deal of the residents time was spent cutting frozens and not doing something educationally related.

It seems that Mayo is valuing speed/turnaround time over quality patient care (turnaround time is not the only marker of quality patient care, and I just don't believe that the quality of the sections at Mayo can be as good as a paraffin H&E done correctly) and resident education.

Just to add 2 more cents - I trained at Mayo for medical school, my husband did his medical school and residency training in a surgical subspecialty there. Frozen section works well at Mayo and the surgeons love it. There isn't a compromising of patient care to allow for rapid turnaround - Mayo has repeatedly studied their frozen section process and published those results in the literature and have a very low rate of error (a 1995 paper noted a 0.1% rate of clinically significant error in the frozen section read). During my rotation through surg path everything was called correctly. Just as with anything, the more you do it, the better you are, and the staff know what they are doing, and also know when to hold something over for the next day to make the call. The fellows sat in the driver's seat and made the diagnosis first, and then it was confirmed by staff. Later in the day the resident got to sit in the driver's seat and make the first call on the slides so they did get to preview things first before the diagnosis was made. In my experience, the resident and I were so busy with grossing that we weren't even paying attention to what they were calling on the slides in the busy, early part of the morning, so preview time the next day was often a 'mystery' anyhow. Additionally, residents see so many H&E slides there it is really ridiculous, from all across the country so there is no shortage of things to preview.

Also it is absolutely not true that the residents have to cut the frozens and are learning nothing. Education is strongly emphasized, even as a med student I think maybe I cut one frozen for fun; otherwise I spent my time learning how to gross and particularly later in the day when things are slower, the staff puts slides up and does more teaching etc.

My advice, if you are interested in Mayo but have doubts, is to go there yourself. My husband and I both had certain things we were skeptical about, but once you are there and see it in action, you see what a well-oiled machine Mayo is, and they do things for a reason. Of all the residents & med students I encountered during my years there, I don't know of a single one who regretted training there. In fact, many colleagues insisted they were going to leave when their training was done, and after going on the interview trail just came back deflated realizing that things weren't as good outside Mayo.

Now, can you survive a Minnesota winter? That is another question... =)

 

[raspberry009]

It really can be a great service to the patients. I never saw a patient get harmed by a frozen section diagnosis there. There is very careful discussion with clinicians, so as to minimize miscommunication.

You have to see it to believe it. I went there somewhat skeptical, as sohsie is, but I am a believer now. That being said, now that I am gone, I will likely never see a Tol blue frozen again.

I completely agree with all of you that have rotated through here. Thanks for adding your oppinions! I wish I have had some discussions with you all BEFORE I ranked. As a PGY1 I do have to say I ranked Mayo high on my list more because of my "gut" feeling. The things that I thought were weaknesses in the program coming in I now see as strengths.

I also want to mention. Its not only fellows that sit in the hot seat. First years sit for 1 hour each day after there first month, second years sit for 2 to 3 hours and so on. When you become a fourth year you become the fellow and sit all day. Having already been in the hot seat for a few hours, I will have to say the T. blue has really made me pay more attention to nuclear features on H and E because it is more of a nuclear stain. But thats neither here nor there.

I just want to say the teaching is awesome here and I couldn't have picked a better place for me. I have learned so much but the load isn't such that I want to have a nervous breakdown. All the faculty are welcoming with questions and encourage dialogue.

To those applying: You really need to see this place before you get turned off by other ppls comments on Mayo. I was so discouraged that I almost cancelled my interview but I'm so glad I didn't. I think it's the "black box" that freaks others out because it's so foreign. But I also agree that there are also plenty of other good programs out there.

 

[raspberry009]

Well, the end result is that mayo residents come out of training and become good pathologists.

But that being said, I spent time there, I didn't like it. You do see lots of biopsies and outside stuff not done on frozen, so it isn't like you never preview or see cases that aren't already diagnosed. Personally I think the frozen diagnosis way of doing every case leaves something to be desired, but it works for them.

You do have a good point. And I know that the ACGME came through and docked the program because of this 3 to 4 years ago. The residents really do need to see the cases that they gross. I don't know when you came through here but they now make sure that you see the cases you gross.

But I also want to add as a first year it is so rewarding to get immediate feedback on what your grossing. "I need another section here because I didn't get a good look of the capsule," or "yup, you got the ureter" or "go back and find the ureter because you gave me a section on artery" or "thats an oncocytoma" (so now I know what an oncocytoma looks like grossly). But I also want to add its a really pain to try and cut fresh colon and make it lay flat. But there is nothin like cutting fresh prostate, its so much better than fixed on finding those 5% adeno lesions.

 

[yaah]

Do AP residents still take no call other than autopsy call?

 

[raspberry009]

I know they take heme call.