Mgh Questions

[Mindy]

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Well, I traditionally have asked if anyone has any questions about what I consider to be the best darn pathology program out there.

So here goes, any questions about my old residency, MGH?

Mindy

 

[caffeinegirl]

I second the motion!

I'll also be happy to answer any questions about MGH, since I'm still here
🙂

 

[Tiki]

Thanks!! I have some questions, I'm coming to interview in early December.

How is your schedule set up on surg path? Do you gross everyday? Is there dedicated preview time? Is it generalized sign out or subspecialty?

And a non-related Path issue, how is living in Boston? I know the housing is ridiculous, so where do most folks live? Do you feel like you have enough after rent to enjoy whatever free time you have? I think the cost of living in Boston is my biggest fear right now, otherwise I'd love to end up at MGH or BID.

 

[caffeinegirl]

Hi Tiki

First of all, before you come, definitely check out our training website:
http://www.massgeneral.org/pathology/train/training.htm

Our schedule on surg path is a "one day" rotation, we sign out in the morning, gross during the afternoon, and preview in the evening. It is a subspecialty sign out, with a weekly rotation on each subspecialty.

As for living in Boston, we do have a higher salary due to the higher cost of living. Many people rent apartments close to the hospital or near the red line (the "T").

Thanks!! I have some questions, I'm coming to interview in early December.

How is your schedule set up on surg path? Do you gross everyday? Is there dedicated preview time? Is it generalized sign out or subspecialty?

And a non-related Path issue, how is living in Boston? I know the housing is ridiculous, so where do most folks live? Do you feel like you have enough after rent to enjoy whatever free time you have? I think the cost of living in Boston is my biggest fear right now, otherwise I'd love to end up at MGH or BID.

 

[King Arthur]

do you end up signing out with fellows a lot? if so, is it a negative to your education? thanks a lot!

 

[Neddy]

do you end up signing out with fellows a lot? if so, is it a negative to your education? thanks a lot!

Our signout system is very subspecialized, so each surg path rotation is one week of signing out a single subspecialty. We have fellows with signout privileges in several surg path subspecialties, and they are assigned service weeks in the same way as attendings. Because of the way the attending and resident schedules are staggered, residents sign out half of their week with one attending or fellow, and half of the week with another. I've signed out half of 3 out of my ~15 surg path weeks with a fellow so far, so the vast majority of my signouts have been with attendings. Also, because each fellow is focused on 1-3 subspecialties for the entire year, they are very good at what they do.

I think the overall advantages of the system (strong fellowship opportunities, different perpective & teaching styles of fellows) definitely outweigh any drawbacks (e.g. fellow signout tends to take longer). That said, I prefer signout with attendings, mainly because our attendings tend to be outstanding teachers.

 

[Mindy]

Hi Neddy and Caffeinegirl! Thanks for hitting these questions. I guess I'll add in my feelings on Boston.

I think that the salary, since it is cost-of-living adjusted in reasonable as long as you do not have two many extra expenditures. There is no need to have a car if you live in Beacon Hill or the West End. By my fourth year, I lived in Southie (~3 miles from MGH), and easily commuted (or rode my bike) daily. The only issue with living far away without a car is if you get called in. I would ride my bike or cab in without much issue if I needed to (and this really only equated to a handful of times my senior year.) Cost aside, Boston is a great city. It is relatively safe, relatively small, and a cool place to live. I intend to stay put here as long as I am able to, and have bought a house.

I too did not sign out very much with fellows. And, likewise, the attendings are such a pleasure to work with that I strongly preferred signing out with them. Of course, signing out with fellows is a bit of a break, because you do feel some of the pressure is off in a relative way.

There is indeed dedicated preview time. In fact, it is pretty much an expectation that you will preview (nearly) all of your cases.

IN short, my experience at MGH was excellent. You work hard, but you learn a lot. See a bit of everything. Without reservation I would recommend it to anyone--well anyone who wasn't in the "lifestyle only" (i.e. banker's hours or die) camp. I particularly recommend it to people who want to feel like they are ready to hit the ground running for their fellowship or job after residency. What I learned at MGH has very smoothly translated to my fellowship.

Mindy

 

[King Arthur]

thanks for the answers guys!

 

[Sean2tall]

I don't have an interview at MGH, but other places in Boston. Any input on what would be a reasonable rent to pay, either living pretty close with public transportation or commuting from a mild distance? Some residents told me they pay in the range of 1600-2000 living pretty close within the city.

 

[Mindy]

I think those rent figures you posted are accurate.

 

[mlw03]

2K per month wasted on rent!? that's rediculous. they'd have to pay 55K/yr to make that comparable to most other cities outside nyc, la, or dc. I better be blown away when i'm up there to make it worth wicked winter and psycho costs of living.

 

[Neddy]

I don't have an interview at MGH, but other places in Boston. Any input on what would be a reasonable rent to pay, either living pretty close with public transportation or commuting from a mild distance? Some residents told me they pay in the range of 1600-2000 living pretty close within the city.

I pay 1425 for a nice 2br a few stops out on the red line on the cambridge/somerville line (with free street parking too). It's a great neighborhood, very safe, with lots of shops, restaurants and bars. There are comparable neighborhoods on the green line which are convenient to the Longwood area, and Tufts is fairly convenient from anywhere, since it's so close to the downtown hub stations. I think BU is a little less convenient for public transportation, but I've heard that there are some "up and coming" areas nearby which are affordable and relatively safe (more so than in the past anyway).

 

[DarksideAllstar]

2K per month wasted on rent!? that's rediculous. they'd have to pay 55K/yr to make that comparable to most other cities outside nyc, la, or dc. I better be blown away when i'm up there to make it worth wicked winter and psycho costs of living.

Seriously, what do you expect? Like any other "desirable" urban area (SF, NYC, DC, etc), you will pay a premium to live there. Looks like the PGY1 salary is about 50K. Here in SF we get about 54K as PGY1, which includes $10K in housing supplements from the medical center and our department. If you plan on living by yourself, expect to pay more. If you are willing to take on a roommate you could probably find a place for about half (~$900/mo). Check out www.craigslist.org to get a feel for rent by area.

Last year around this time I compared living in Seattle and San Francisco for residency using a cost of living calculator (comparing SF$ and SEA$) using last year's salary figures. Even with ~$10K/yr difference in salary between the programs, I would have come out AHEAD ~$4K/yr living in Seattle.

 

[FindingMyself]

I pay $900 a month for a huge two-bedroom in East Boston. Some people say it's not the best place to live, but I'm very happy there. It's a mainly Hispanic neighborhood.

 

[CameronFrye]

I have a good friend who is a resident at the Brigham. He has a fairly nice 1 BR apt in Brookline that runs around 1500 a month. Cheaper options are certainly around, but you have to be willing to hustle to track them down.

My opinion is that living costs should be a secondary consideration when choosing a residency (at least for single residents). If your favorite program is in a high cost of living area, go for it. You aren't going to starve and you should still have enough money to enjoy some of the city's amenities. (That being said, I'm certainly not complaining about my $400/month rent. That leaves me with plenty of money to visit my friends who do live in expensive cities).

 

[mlw03]

Seriously, what do you expect? Like any other "desirable" urban area (SF, NYC, DC, etc), you will pay a premium to live there. Looks like the PGY1 salary is about 50K. Here in SF we get about 54K as PGY1, which includes $10K in housing supplements from the medical center and our department. If you plan on living by yourself, expect to pay more. If you are willing to take on a roommate you could probably find a place for about half (~$900/mo). Check out www.craigslist.org to get a feel for rent by area.

Last year around this time I compared living in Seattle and San Francisco for residency using a cost of living calculator (comparing SF$ and SEA$) using last year's salary figures. Even with ~$10K/yr difference in salary between the programs, I would have come out AHEAD ~$4K/yr living in Seattle.

i guess it comes down to what one considers desireable. i don't consider boston, san fran, nyc, la, etc "desireable" places to live based on what's important to me. i applied to the boston area programs, in spite of their being in a city i'm not in love with, because they're supposed to be good. i agree with what cameron said - if your dream program is in an expensive city, suck it up for 4 years. however i know that excellent training can be found in lots of places, and i'll freely admit here or to any PD that liveability will factor into my rank list. how big a factor, i don't know. liveability at the expense of quality training is a poor choice i don't advocate, but i do believe one can get both - a program they're excited to be at in a city they're happy living in. how we each define those things is what makes this process such a challenge.

 

[DarksideAllstar]

i guess it comes down to what one considers desireable.

That's why I put desirable in " " in my first post.

 

[pathstudent]

Seriously, what do you expect? Like any other "desirable" urban area (SF, NYC, DC, etc), you will pay a premium to live there. Looks like the PGY1 salary is about 50K. Here in SF we get about 54K as PGY1, which includes $10K in housing supplements from the medical center and our department. If you plan on living by yourself, expect to pay more. If you are willing to take on a roommate you could probably find a place for about half (~$900/mo). Check out www.craigslist.org to get a feel for rent by area.

Last year around this time I compared living in Seattle and San Francisco for residency using a cost of living calculator (comparing SF$ and SEA$) using last year's salary figures. Even with ~$10K/yr difference in salary between the programs, I would have come out AHEAD ~$4K/yr living in Seattle.

That's nice of the med center and dept to boost your salary, 10k. When I was applying, there was only a 4k housing bonus.

 

[raspberry009]

Well, I traditionally have asked if anyone has any questions about what I consider to be the best darn pathology program out there.

So here goes, any questions about my old residency, MGH?

Mindy

My interest is in: how happy are the residents? Do they look forward to coming to work every day? I don't mind the hours, but I don't believe I'll do well in an environment when I'm getting put down and grilled. Everyone is saying stay here! don't go Northeast where you learn a lot but have ulcers and have lost all your hair. I personally like my hair. but are these assumptions true?

 

[LADoc00]

Wonder if anyone does the math like this:
Boston/SF/NYC monthly rent 2000x48 month residency=96,000+utilities/parking
Price of staying the "dorm" building in St. Louis@WashU=318/mo=15,300 includes all utlities and parking, no commute

80K difference invested for 10 years at meager 8% return=172,000 or roughly the price the price of 4 years of med school.

Shocking huh. Wait it gets better.

Cost of Living Index (COLI) of Idaho vs. NYC/Boston 0.5, net reimbursements 2-3x, COLI adjusted differential = 4-6x
given base salary of 200 in Boston, someone in Idaho will have acquired a net worth in excess of 10x what the Boston pathologist will by the age of 40 given no incredible inside stock info or real estate deal a Bostonian might acquire. Even if the Idaho guy is banking ONLY an additional 100K(would be in reality 2-3x this much) a year after expenses into a additional retirement account, that is 3.2 MILLION DOLLARS more in a mere 15 years of full time work. Which means that by the age of 45, the Idaho pathologist could be semi-retired living Boston and working only part time while the native Bostonian is still cranking 40+hrs/week. Who will be drinking Guinness at the Black Rose in Boston with a giant shiat-eating grin on their face?

 

[Faebinder]

Wonder if anyone does the math like this:
Boston/SF/NYC monthly rent 2000x48 month residency=96,000+utilities/parking
Price of staying the "dorm" building in St. Louis@WashU=318/mo=15,300 includes all utlities and parking, no commute

80K difference invested for 10 years at meager 8% return=172,000 or roughly the price the price of 4 years of med school.

Shocking huh. Wait it gets better.

Cost of Living Index (COLI) of Idaho vs. NYC/Boston 0.5, net reimbursements 2-3x, COLI adjusted differential = 4-6x
given base salary of 200 in Boston, someone in Idaho will have acquired a net worth in excess of 10x what the Boston pathologist will by the age of 40 given no incredible inside stock info or real estate deal a Bostonian might acquire. Even if the Idaho guy is banking ONLY an additional 100K(would be in reality 2-3x this much) a year after expenses into a additional retirement account, that is 3.2 MILLION DOLLARS more in a mere 15 years of full time work. Which means that by the age of 45, the Idaho pathologist could be semi-retired living Boston and working only part time while the native Bostonian is still cranking 40+hrs/week. Who will be drinking Guinness at the Black Rose in Boston with a giant shiat-eating grin on their face?

Sometimes, I think you are a genius.... but then I realize.. you are just not full of ****, which seems to be a syndrome in medicine that many suffer. The above is a great answer. Which comes back to the OP's question... Everyone has different criterias for what is a "great" residency? Money? Least Work Hours? Availability of Hotties in the path lab?

 

[LADoc00]

Sometimes, I think you are a genius.... but then I realize.. you are just not full of ****, which seems to be a syndrome in medicine that many suffer. The above is a great answer. Which comes back to the OP's question... Everyone has different criterias for what is a "great" residency? Money? Least Work Hours? Availability of Hotties in the path lab?

hold it, so I *was* a genius and not am I simply not made of excrement?! Or are you implying I was made of excrement, then I hatched into a larval batch of semi-intelligent maggots capable of surfing internet newsgroups?

 

[Faebinder]

hold it, so I *was* a genius and not am I simply not made of excrement?! Or are you implying I was made of excrement, then I hatched into a larval batch of semi-intelligent maggots capable of surfing internet newsgroups?

Hmmm... starting to wonder if I need an AAS on you to see if you are FoS. I'm complimenting you sheesh, just saying that you are telling everyone what they are thinking and not saying.

(I forgot this is the pathology forum)
AAS = Acute Abdominal Series
FoS = Full of ****

 

[LADoc00]

Hmmm... starting to wonder if I need an AAS on you to see if you are FoS. I'm complimenting you sheesh, just saying that you are telling everyone what they are thinking and not saying.

(I forgot this is the pathology forum)
AAS = Acute Abdominal Series
FoS = Full of ****

ah k, sounds good. So your Dx is that Im Poo-free atm or feces-light. gotcha.😉

 

[caffeinegirl]

My interest is in: how happy are the residents? Do they look forward to coming to work every day? I don't mind the hours, but I don't believe I'll do well in an environment when I'm getting put down and grilled. Everyone is saying stay here! don't go Northeast where you learn a lot but have ulcers and have lost all your hair. I personally like my hair. but are these assumptions true?

Ulcers? Telogen effluvium! OMG! Wow...that is something I've not seen here at all. And we are overall quite a happy bunch of people. The thing about MGH, is that we're definitely not a 9-5 program and we're pretty up front about it. We have a larger specimen volume, and thus more work to do. So, I think we self-select in a way, such that people who want a more rigorous program choose to come here.

At least in my opinion, we do look forward to coming to work everyday, and enjoy pathology as a whole, which makes us also quite a bunch of enthusiastic residents as well! Our environment is not even close to that of a huge rift between attendings and residents...we get along really well...and we're not a formal program (ie. scrubs QD is ok on AP, with residents AND attendings). Getting grilled for the sake of getting grilled is not anything I've seen here either. Even our Outs conference (daily unknown conference) isn't a huge pimping experience either. Sure there are a few exceptions (as there are in any program) but our overall environment is a work hard/learn hard/play hard mentality.

 

[sleeping beauty]

i heard a lot people saying residents there are not happy.

tell me your working hours. from 7:00am to 10:00pm? 7 days a week?

 

[King Arthur]

I heard "work hard/play hard." do the residents acutually hang out together and play hard? if so, big + in my book

 

[Neddy]

My interest is in: how happy are the residents? Do they look forward to coming to work every day? I don't mind the hours, but I don't believe I'll do well in an environment when I'm getting put down and grilled. Everyone is saying stay here! don't go Northeast where you learn a lot but have ulcers and have lost all your hair. I personally like my hair. but are these assumptions true?

Most residents are happy here, but like caffeinegirl said, we are somewhat self-selected for people who like to work hard. IMHO, the programs you want to avoid are the ones where residents came expecting it to be a cakewalk and end up bitter that they don't get home at 6 every day. As for the ulcers/grilling/put-downs stuff, I think you are confusing us with the surgery program.

 

[caffeinegirl]

i heard a lot people saying residents there are not happy.

tell me your working hours. from 7:00am to 10:00pm? 7 days a week?

We get this a lot every interview season. Unfortunately it's due to remnants of the pre- 80hr work week era, where residents were grossing until odd hours of the night and even early morning (yikes!). It's no wonder that some graduates from that era may still feel rancor towards their days as a resident.

I do not think that current residents are unhappy with our program (see my prior post). As for working hours...if we were to work from 7-10 then we would be going against the 10 hour off daily work rule. Our program is pretty vigilant about this rule, and they check our work hour logs on a weekly basis.

Anyway, we sign out with attendings at 8am, have an unknown conference from 12:30-1:30, and have all afternoon until 8pm to gross. Slides come out from noonish until about 6:30ish. So, the workday depends on the type of service you're on (small or large) and the volume you'll get, and when your specimen comes in for grossing...lots of factors! So there is no typical surg path day. However, there are typical GI large days, which run from 8-10pm easily, and typical GI small days, which run from 8-6ish with lots of down time in between. As for weekends, there is no sign out on the weekend, and no slides are cut on the weekend. So, consider it as extra time to preview and/or gross if you have stuff fixing/decalcifying from the week. This time is flexible as well... The recurring theme in our program is flexibility. You just have to get the job done by signout, and stay within the work hour limits...which is TOTALLY do-able.

We're just talking about surg path here..not CP at all..which is a whole other schedule, that varies depending on the service as well.

Hope this helps...!! It's great that Neddy and Mindy are here to pipe in as well...I think maybe, just maybe we can lay this myth to rest!

🙂

 

[sleeping beauty]

how many specimens do you gross in a big GI day? what's the total annual surgpath specimen volume?

 

[caffeinegirl]

We have grossing "lists" that get set up everyday for the residents. So, you don't gross everything that comes in for that service. The specimens are chosen based on the educational value as well (ie. you won't get lots of tics everyday). The rest gets done by PA's. The amount you gross depends on what stage of your training you're in. You'll have less your first week, more during the bulk of your training, and less as a senior. The actual guidelines aren't set in stone, and you can get help from the PA's as well. For GI large, your limit as a non-first timer or non-senior is currently 7 cases/day. I must say that our entire program is quite flexible, and that our "guidelines" change as our PD gets feedback from us, so this is a recent change, and we're still playing it by ear.

As for the annual specimen volume..well..we're close to 70K right now.

 

[sleeping beauty]

7 cases/day? 7 biopsies? or 7 pancreas cancers from whipple?

 

[Neddy]

7 cases/day? 7 biopsies? or 7 pancreas cancers from whipple?

PA's do all of the non-neoplastic appendixes, gallbladders, stoma excisions, and many of the routine non-tumor colons (tics etc). Techs do biopsies. We do most of the cancers and unusual cases. 3-7 Whipples per week is the usual range, with about the same in distal pancs. Esophagi, small bowel tumors, and liver explants or wedges show up most weeks as well.

 

[LADoc00]

As for the annual specimen volume..well..we're close to 70K right now.

I want to mention a point I feel strongly about: surgical accession numbers are MEANINGLESS, anyone who looks at those too closely at this when deciding programs to attend deserves what they get.

 

[caffeinegirl]

I want to mention a point I feel strongly about: surgical accession numbers are MEANINGLESS, anyone who looks at those too closely at this when deciding programs to attend deserves what they get.

I totally agree...remember that an accession number is equivalent for an acrochordon and a BKA for osteosarc!

 

[mlw03]

I totally agree...remember that an accession number is equivalent for an acrochordon and a BKA for osteosarc!

care to translate what that means for those of us who aren't residents or attendings yet? by the way, i do agree that solely looking at number of specimens is a silly thing to do.

 

[raspberry009]

I second that motion!

 

[caffeinegirl]

care to translate what that means for those of us who aren't residents or attendings yet? by the way, i do agree that solely looking at number of specimens is a silly thing to do.

Accession number = identification number given to each patient's specimen (also known as case number). One number is given per patient's procedure. So if multiple specimens get taken out in one procedure (ie. lung wedge and lymph nodes) they all get one accession number, with a letter/number per specimen. Example: A patient undergoes a lobectomy and mediastinoscopy. All specimens from that procedure are given the same accession number. The lung gets identified as specimen A, mediastinal lymph node as specimen B, and so on. I've seen cases with AA+ specimens (ie, we've gone to Z and have to start over again!)

Acrochordon: fancy word for a skin tag

BKA: below the knee amputation

Osteosarc: osteosarcoma, a really bad bone tumor.

LADoc's and my points were that when we talk about surgical specimen volume, we talk about accession numbers. So, even though we have 70K surgical cases accessioned, this has NO relevancy to the NUMBER of specimens, and the COMPLEXITY of the case. So, the number doesn't really mean anything.

 

[malchik]

So, even though we have 70K surgical cases accessioned, this has NO relevancy to the NUMBER of specimens, and the COMPLEXITY of the case. So, the number doesn't really mean anything.

That being the case, what criteria should applicants use to get an idea of specimen complexity at a program?

 

[mlw03]

ah, thanks. with the defintion of "Acrochordon" i get what you're saying - that total case number doesn't at all account for complexity or type of cases.

 

[caffeinegirl]

That being the case, what criteria should applicants use to get an idea of specimen complexity at a program?

Hmmm..Great question, and I'm sure others would like to pipe in as well.

I think it's a combination of surgeons/surgery service as well as pathologists. So, some questions to ask would be the number of OR's, the size of the pathology department, and how many specimens residents gross per day. Also, the type of specimens..how many Whipples would you expect to see during your entire residency? Laryngectomies? Tumor amputations?

I'm sure others have better suggestions..?

 

[Mindy]

Well, this topic has taken off...

Here is the way I feel, I kinda like the "MGH monster" mythology. Because, I clearly have survived the "MGH monster". And whether or not folks want to admit it, that fact by itself provides us (ex-) residents quite a bit of respect. I can already anticipate LA's response to this, but I also know he knows it true.

Now the "truth" is, MGH pathology is a place where residents and attendings work hard. It is a place where residents who want to make a name for themselves can. I know that there are a whole bunch of people who want to become pathologists so that they can retreat into their offices with stacks of slides and have a pleasant, easy-breezy life. But, there are also a bunch of people who want to have an impact on the field of pathology. The people who want to make an impact can get a good start at MGH. They can look around at their role models / mentors (i.e attendings) who have all made an impact in the field.

So, to answer the questions about happiness, I think it goes along with how much one cares about trying to achieve excellence in their fields. At MGH, most of the "self-selected" residents (as Neddy pointed out), are happiest trying to achieve a sense of mastery over pathology. Are football players always happy running wind-sprints? Does it mean they are unhappy playing football?

If you want a program where by the end of it you feel exceptionally well equipped not only to step out and practice pathology, but also to change the practice of pathology, MGH fits the bill.

Is it the ONLY program? No. BUT, it is the ONLY Mass General 😉

Mindy

 

[raspberry009]

Thank you Caffeinegirl and Mindy. I am a firm believer in "no man is an island." I am very interested in pathology. And i just wanted a chance to clarify my question. When it comes to the programs that have long work hours, it seems like a battlefield. There have been studies that show that soldiers perform at their best when they trust the man that is standing beside them. It doesn't depend on how much they love their country, ect, but its all about the man that is standing beside you. Now when you're pulling that horrific shift in surg path, you had a bad call night last night, you're tired, you have the never ending amount of tissues that need to get taken care of. Do your collegues help out and vice versa? or do they say suck it up? I realize this is extrapolated just a tad. But when your pulling 80+ hours in surg path, I really would like to trust the people that are working next to me to help it feel like 80 hours, not eternity.

 

[mlw03]

i think a useful correlary question to ask, and this applies to all the programs where the surg path hours are 70+ per week: do those extra hours make you a better pathologist in the end? obviously this is subjective, but does working an extra 2-4 hours per day during the surg path rotations really lead to greater diagnostic skills by the end of residency? mindy points out that MGH has residents and attendings that work hard, but if that just means they're working more hours because the volume is higher, then what's the advantage? is signing out more routine cases a better use of the resident's time than going home and reading for 2 hours about less common cases? i don't know the answer to these questions, but i'll be curious to see what the upper level residents think.

 

[b&ierstiefel]

i think a useful correlary question to ask, and this applies to all the programs where the surg path hours are 70+ per week: do those extra hours make you a better pathologist in the end? obviously this is subjective, but does working an extra 2-4 hours per day during the surg path rotations really lead to greater diagnostic skills by the end of residency? mindy points out that MGH has residents and attendings that work hard, but if that just means they're working more hours because the volume is higher, then what's the advantage? is signing out more routine cases a better use of the resident's time than going home and reading for 2 hours about less common cases? i don't know the answer to these questions, but i'll be curious to see what the upper level residents think.

There are a couple issues at hand here regarding work hours (granted, I'm not at MGH but at another Boston institution across the river). Working long hours at the start of residency is different than working long hours later in residency. When one is a junior resident who, like myself, knows nothing about pathology (cuz my decision to enter pathology was late in the game and I didn't develop any pathology skills during med school) starts residency at a high volume center, one works long hours due to inefficiency. In that setting, one will even struggle with the routine cases and will have absolutely have no idea what to do with challenging cases. And I'm operating under the assumption that the majority of the caseload in pathology are routine cases and it is the few challenging ones that makes one's work exciting. This is the first hump of the bimodal learning curve. One issue that may be raised here is that "is high volume bad because it leaves less time for reading?" Well, it depends on how you learn but what you DO learn by seeing lots of cases is an appreciation of the clinicopathologic correlates and impact of your diagnosis on management and how one should manage the mere routine case given different clinical settings (i.e., the PRACTICAL aspects of pathology...how to keep your clinicians happy and doing what you can to not get screwed by lawyers...the art of pathology...the art of covering your ass). Books cannot teach you this. Books will present many esoteric entities, some of which you will not see. Reading is useful, however, in being aware of differential diagnoses...but experience can give you that too.

Now, working long hours as a senior resident is a different beast. You can do the routine cases efficiently...you're faster, you're smarter...but then you deal with these little cases called consults. That represents a jump from Pathology 101 to Pathology 202, so to speak. The challenge of cracking these cases is exciting and fulfilling if you can solve them...working long hours in this setting is different because your work is more self-motivated rather than feeling like you're being overwhelmed by a sheer number of cases. Here, reading becomes more directed, more useful, and more likely to be retained in your mind. See, before, your reading is done in a sheer blinded fashion...you may be reading for the sake of reading with the mentality of "I need to force myself to read 30 pages of Rosai every night" (that's if you're one of these folks who like to keep a text by your pillow at night).

So after a few years of residency training, that is my outlook. My answer may be long-winded but hopefully the point I wanted to get across is somewhat clear. In general, everybody learns differently...but I learn by seeing cases and managing them. I think I have benefitted from putting in my hours. Now, when I start studying for AP boards, I may have to revamp my opinions...but all the residents in our program who just took AP boards all passedand many of them didn't read 20 pages of Rosai every night. And they're gonna be great pathologists!

 

[CameronFrye]

There are a couple issues at hand here regarding work hours (granted, I'm not at MGH but at another Boston institution across the river). Working long hours at the start of residency is different than working long hours later in residency. When one is a junior resident who, like myself, knows nothing about pathology (cuz my decision to enter pathology was late in the game and I didn't develop any pathology skills during med school) starts residency at a high volume center, one works long hours due to inefficiency. In that setting, one will even struggle with the routine cases and will have absolutely have no idea what to do with challenging cases. And I'm operating under the assumption that the majority of the caseload in pathology are routine cases and it is the few challenging ones that makes one's work exciting. This is the first hump of the bimodal learning curve. One issue that may be raised here is that "is high volume bad because it leaves less time for reading?" Well, it depends on how you learn but what you DO learn by seeing lots of cases is an appreciation of the clinicopathologic correlates and impact of your diagnosis on management and how one should manage the mere routine case given different clinical settings (i.e., the PRACTICAL aspects of pathology...how to keep your clinicians happy and doing what you can to not get screwed by lawyers...the art of pathology...the art of covering your ass). Books cannot teach you this. Books will present many esoteric entities, some of which you will not see. Reading is useful, however, in being aware of differential diagnoses...but experience can give you that too.

Now, working long hours as a senior resident is a different beast. You can do the routine cases efficiently...you're faster, you're smarter...but then you deal with these little cases called consults. That represents a jump from Pathology 101 to Pathology 202, so to speak. The challenge of cracking these cases is exciting and fulfilling if you can solve them...working long hours in this setting is different because your work is more self-motivated rather than feeling like you're being overwhelmed by a sheer number of cases. Here, reading becomes more directed, more useful, and more likely to be retained in your mind. See, before, your reading is done in a sheer blinded fashion...you may be reading for the sake of reading with the mentality of "I need to force myself to read 30 pages of Rosai every night" (that's if you're one of these folks who like to keep a text by your pillow at night).

So after a few years of residency training, that is my outlook. My answer may be long-winded but hopefully the point I wanted to get across is somewhat clear. In general, everybody learns differently...but I learn by seeing cases and managing them. I think I have benefitted from putting in my hours. Now, when I start studying for AP boards, I may have to revamp my opinions...but all the residents in our program who just took AP boards all passedand many of them didn't read 20 pages of Rosai every night. And they're gonna be great pathologists!

Agreed. A couple of other points:

Reading for most new pathology residents is fairly low yield. Of course, reading about your cases and when preparing for conferences is useful, but "cold" reading is very frustrating (and slow going) until you develop a foundation.

The question of a "reading vs. doing" residency is somewhat of an artificial distinction anyway. When I'm on surg path, my reading time is very limited. However, that's only 10 months out of my four year residency. Sure, I've had the occasional busy autopsy or heme month, but in general, I have plenty of time to read when not on surg path.

 

[mlw03]

excellent points guys - thanks for your responses

 

[Trenchcoat]

I'd really like to interview at MGH. Any tips for phoning in to increase my chances of getting an interview?

 

[magician]

I'd really like to interview at MGH. Any tips for phoning in to increase my chances of getting an interview?

is there any way we can exchange programs to interview? you take my mhg spot and i take one of your spots (i like both large and middle size programs but I like middle size programs better).

 

[yaah]

is there any way we can exchange programs to interview? you take my mhg spot and i take one of your spots (i like both large and middle size programs but I like middle size programs better).

Why'd you apply then? And why does it say you're a podiatrist under your avatar? Podiatrist path is pretty boring. Verruca. Verruca. Verruca. Normal bone (history of bunion). Verruca. Verruca. Verruca. Ganglion.