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!
