New attendings

[yaah]

I am "breaking in" a new attending this week. It is his first week since he started here last year on GYN path signout. Up until now has just been doing research and cytology. So, it's the first time on surg path since residency, before fellowship. It's interesting. I almost feel like I have to be more attentive on previewing now - has anyone else had this experience? I had the same experience last october. Maybe I just get assigned new attendings.

He got off a good line though - we had a cervical biopsy on a 50 year old woman with a pap smear showing LGSIL (prior to this year she had been normal for years). Biopsy also showed LGSIL. He said that in his training program they referred to this (new HPV lesion in a 50 year old) as the "Viagra effect."

Of course we also got a couple of irritating biopsies - one which is a difficult distinction between endometrial hyperplasia and secretory endometrium. And a radical vulva for Paget's disease which also contains a compound nevus. Is it invasive disease or is it just the nevus?

It makes me wonder though. Due to the volume here, I have probably seen more GYN biopsies at this point (through two two-week rotations through the service) than lots of residents do in their entire training. And they would then go onto a job and have to sign them out. Frightening.

---

Members don't see this ad.

 

[AngryTesticle]

Yes this has happened to me too.

 

[yaah]

Yeah, well interestingly, he has a couple of cases he was curious about, but he wants to show them to the expert himself. This is an interesting development which I have not seen before. Perhaps it is because he is fresh out of fellowship and has yet to develop the ego that many have. The problem with showing slides on the gyn-path rotation is that the expert's office is a 10-15 minute walk.

 

[beary]

It makes me wonder though. Due to the volume here, I have probably seen more GYN biopsies at this point (through two two-week rotations through the service) than lots of residents do in their entire training.

Hey yaah - what do you think of the two-week rotations? I was afraid that would be a little bit too frequent changes - like by the time you got things running smoothly it would be time to switch to something else. I know AT has talked about one week rotations at BWH - I could never handle that!

Of course I am just asking out of sheer curiosity with no ulterior motive like trying to figure out my ROL or anything.

 

[AngryTesticle]

I could never handle that!

Yeah, nobody's perfect

 

[yaah]

Hey yaah - what do you think of the two-week rotations? I was afraid that would be a little bit too frequent changes - like by the time you got things running smoothly it would be time to switch to something else. I know AT has talked about one week rotations at BWH - I could never handle that!

Of course I am just asking out of sheer curiosity with no ulterior motive like trying to figure out my ROL or anything.

It works out fine. It is enough time to get familiar enough with things so you learn more than just simple diagnoses. I am not sure if I would prefer a month at a time on these services. It works well for the main grossing rotation, but for GI and Gu, etc, it's fine. It's true though, you do kind of feel sometimes as though you are switching quickly, but that sort of happens with a month worth too.

 

[AngryTesticle]

Yeah, well interestingly, he has a couple of cases he was curious about, but he wants to show them to the expert himself. This is an interesting development which I have not seen before. Perhaps it is because he is fresh out of fellowship and has yet to develop the ego that many have. The problem with showing slides on the gyn-path rotation is that the expert's office is a 10-15 minute walk.

Who's the big vag path guru at Michigan?

I totally hear ya regarding taking long walks to show slides to attendings. The worst is if I have to show slides to Derm and Breast service in the same afternoon. It's like 3 points in an obtuse triangle...makes for some walking for sure.

All in all though, you gotta do what you gotta do to make the best diagnosis possible even if it requires burning a few hundred calories!

 

[pathdawg]

Yeah, well interestingly, he has a couple of cases he was curious about, but he wants to show them to the expert himself. This is an interesting development which I have not seen before. Perhaps it is because he is fresh out of fellowship and has yet to develop the ego that many have. The problem with showing slides on the gyn-path rotation is that the expert's office is a 10-15 minute walk.

He just wants to benefit and learn from the expert. Being an inexperienced attending is pretty tough. Working without a net is intimidating at first. Its actually really good experience for you to work with a new guy like that. Remember him when you are in that position.

 

[pathdoc68]

I have unfortunately/fortunately had the honor of "breaking in" numerous attendings, and I see a few more newbie "break in" opportunities in my near future. Yes, it is very painful, yes it can be beneficial. (You learn about the way things are done elsewhere)

I have done more than my share of showing cases, so I really sympathize with your sentiments. My outfit recently started a daily staff conference where staff can show the cases to eachother themselves and this has cut down on residents having to show cases around. Finally, I agree with the poster above it is genuinely stressful on new faculty, so I try to be as supportive as possible.