Organization of surgical pathology at your institution

[Patrick O]

In my program turnaround time is given high priority, and as such we are on a 2 day surgical pathology schedule. Gross on day 1, then signout on day 2. This is the general approach, but some attendings let you preview the cases overnight and signout in the morning on day 3 (you will be cutting this day but in general most surgical specimens don't come until the early afternoon). We cover a particular specialty service for a week at a time. I am interested in knowing how others balance their exposure on frozen section and is it while you are covering a surg path service. Do you cover for the whole day, half day? Do you take a week at a time? If we are covering a biopsy rotation, we are not on frozens and generally don't gross these specimens unless they are more complex (for example breast excisional biopsies). While on larger services like Gyn/Breast and GI we do half days of frozen section coverage for the entire week. As you can imagine this can be pretty hectic depending on the surgpath cutting/frozen schedule and time management becomes of paramount importance. Our program does have a dedicated frozen section month split with immunohistochemistry as a senior level rotation. Any input would be much appreciated, especially from those in a similar 2 day type cycle. Thanks.

---

Members don't see this ad.

 

[mlw03]

this could be a useful thread for future applicants, so if ya'll are willing, it'd be helpful to say which program you're at (and if there is variation in the surg path schedule at various institutions within the program, it'd be helpful to know that as well).

 

[yaah]

Michigan:

Subspecialty signout for GI, GU, Breast, GYN. GI and GU are AM signout. Slides come out for the next day in the afternoon, the afternoon is for grossing any cases that are left (PAs gross in the morning, things that came in late in the previous day) and previewing for the next day. Breast and Gyn are afternoon signout. Slides come out at 8-9am, small cases (biopsies) are previewed and signed out the same day. Larger cases can be previewed and held until the next day for more preview time (up to resident, if there isn't much to gross usually you can preview most of everything). Thus on all 4 of these cases you gross, signout and preview every day.

The other surg path rotation includes everything else (lung, endocrine, soft tissue, bone, head and neck). Two residents are on, how it basically works is that one resident grosses while the other previews and signs out. You switch every two days so that you get to preview and sign out most of what you gross. You can always preview and attend signout "informally" if you don't have much to gross or you are efficient (like me 😉 ). The preview resident also covers frozens in the afternoon (a surg path fellow covers in the morning until noon). So you get frozen experience there as well as when you are on call. Can also do a month as surg path fellow during fourth year.

Personally I don't know why people prefer getting the entire day to preview followed by signout the next day (or whatever variation). Unless the volume is HUGE and signout goes on for 6-7 hours. Our signouts go on for 3-4 hours and we have ample time to do the other things. Some days are obviously busy and hectic but such is life, and it is good experience.

Having gone through 3.5 years of resident plus 1 year of PSF, I would not train at a place that didn't give you ample preview time (by this I do not mean getting the slides 1-2 hours before signout and giving them a quick perusal and cursory review of history). Preview time IMHO is crucial to training and growth of residents.

 

[CameronFrye]

UVA:

General surg path signout, four day schedule:

Day 1, Frozens: Your primary responsibility is to cover frozens. You are also the on-call anatomic pathology resident on these days. During down times (some days are slow, others are chaotic) you take care of your pending cases, help the grossing resident, sit it on "smalls" signout, etc.

Day 2, Grossing: You gross in the "mains" cases. There are also PA's, histotechs, and the frozen resident to help with the grossing.

Day 3, Smalls: This is the long day in the schedule. Your "smalls" (biopsies) stack comes out around 7:30. You then have an hour or two to preview them before signing out with the attending. This usually stretches until lunchtime, but sometimes goes longer. After signout, you dictate your cases and order any immunos/special stains/etc. Your "mains" cases come out around 2 or 3. You then have the rest of the day/night to preview as much or as little as you want.

Day 4, Mains: This is the short day of the schedule. You sign out your cases with the attending. Once finished, you once again dictate, order stains, etc. Once all of your cases are wrapped up, you then fetch the next day's OR schedule and get ready for any possible frozens the next day (look up histories, pull old case material, etc.).

Next day: Repeat cycle.

 

[Patrick O]

Thanks for your input everyone.

So Cameron, if you don't sit in on signouts with other attendings on your frozen day, it looks like you are signing out 1 full day (on day 3) and part of a day (on day 4). Are you splitting time with different attendings (ie. pathologists assigned to biopsies and pathologists assigned to "large" cases)? Does your surgpath rotations change as a senior resident (ie. mostly signout and no grossing, not including for example a "surgpath fellow" month). I am asking these questions to get some ideas that we might try implementing in our program. A great deal of the problem that in our current schedule lies with difficulties in the histotech arena, with personnel coming and going and slide delivery gradually getting increasingly delayed. When I first started as a resident 3 years ago most biopsy slides were out 8 am. Services like derm and GI were out around 7am. Even the "large cases" were definitely out by noon. Those were the days.

For example, when we are assigned a large service (lets say gyn/breast), our schedule will look something like this:

Day 1 : Frozens 12-5, gross the entire large service for the day (mastectomies, breast excisions with sln, prostate, a rare bladder, oncologic and non-oncologic gyn procedures, testes.....)this means while you are grossing you are pulled from the bench to go to a frozen... a real pain

Day 2 : Frozens section 8-12, preview/signout cases from the previous day, all depends when the slides are delivered

Day 3 : Frozens either 8-12 or 12-5, signout leftovers from the night before with the attending (this is where it gets tricky b/c if your on frozens and signing out the overlap can have you constantly leaving the signout to go to a frozen) and afterwards gross the entire service again

There are some attendings that want us to signout every day on large service. This can really cause a hassle even if you are as efficient as hell, because you are relying on the efficiency of the attending, and praying the surgical schedule for the day won't strap you to the grossing bench.

We do have PAs and biopsy techs (cover all derm, GI, and other services that another resident isn't covering) but when you are on a service typically you are grossing all the specimens for that service. We do around 50k surgicals a year.

We also have 3 month unbroken blocks of TMS, Chemistry, Micro, Heme and Cytogenetics. The other CP rotations are typically 1 month.

Any changes we implement won't really benefit me because I had a front loaded AP schedule....most of the SP I will do in the future in the 4th year will be on a predominantly signout basis only. However the junior residents could benefit.

 

[CameronFrye]

Thanks for your input everyone.

So Cameron, if you don't sit in on signouts with other attendings on your frozen day, it looks like you are signing out 1 full day (on day 3) and part of a day (on day 4). Are you splitting time with different attendings (ie. pathologists assigned to biopsies and pathologists assigned to "large" cases)? Does your surgpath rotations change as a senior resident (ie. mostly signout and no grossing, not including for example a "surgpath fellow" month). I am asking these questions to get some ideas that we might try implementing in our program. A great deal of the problem that in our current schedule lies with difficulties in the histotech arena, with personnel coming and going and slide delivery gradually getting increasingly delayed. When I first started as a resident 3 years ago most biopsy slides were out 8 am. Services like derm and GI were out around 7am. Even the "large cases" were definitely out by noon. Those were the days.

For example, when we are assigned a large service (lets say gyn/breast), our schedule will look something like this:

Day 1 : Frozens 12-5, gross the entire large service for the day (mastectomies, breast excisions with sln, prostate, a rare bladder, oncologic and non-oncologic gyn procedures, testes.....)this means while you are grossing you are pulled from the bench to go to a frozen... a real pain

Day 2 : Frozens section 8-12, preview/signout cases from the previous day, all depends when the slides are delivered

Day 3 : Frozens either 8-12 or 12-5, signout leftovers from the night before with the attending (this is where it gets tricky b/c if your on frozens and signing out the overlap can have you constantly leaving the signout to go to a frozen) and afterwards gross the entire service again

There are some attendings that want us to signout every day on large service. This can really cause a hassle even if you are as efficient as hell, because you are relying on the efficiency of the attending, and praying the surgical schedule for the day won't strap you to the grossing bench.

We do have PAs and biopsy techs (cover all derm, GI, and other services that another resident isn't covering) but when you are on a service typically you are grossing all the specimens for that service. We do around 50k surgicals a year.

We also have 3 month unbroken blocks of TMS, Chemistry, Micro, Heme and Cytogenetics. The other CP rotations are typically 1 month.

Any changes we implement won't really benefit me because I had a front loaded AP schedule....most of the SP I will do in the future in the 4th year will be on a predominantly signout basis only. However the junior residents could benefit.

Each week, we have two attendings who are on service. The first attending signs out smalls/frozens (at the same multihead scope) on M/W/F and mains on Tuesday and Thursday. The other attending has the opposite schedule. Therefore, you end up having the same attending for all of your signouts that week.

Our overall schedule roughly looks like this:

1st year (AP): 5 months surg path, 5 months autopsy, 1 month derm, 1 month cytology

2nd year (CP)

3rd year (AP): This year is currently in flux, but looks something like 5 months surg path, 2 weeks autopsy supervision, 2 weeks gross room supervisor, 2 months cytology, and then there is some combination of renal, forensics, neuropath, and derm.

4th year (6 months AP, 6 months CP): 4th year AP residents spend no time on the general surg path service and have a good bit of elective time. They also cover "in-and-out" cases. These are outside slides of patients being referred to UVA for treatment. 4th year residents also spend time on true consults. Dr. Mills has a consult signout every afternoon and Dr. Wick also gets a fair amount of consults. These are handled by the 4th years and fellows. 4th years also take "fellow's call". That is, they will read overnight frozens (with attending backup available if needed). 4th years in the past have also done away rotations, such as with Bostwick.

I hope that helps. Also, I can empathize with the problem with histotech turnover. It seems to be a common theme at academic med centers. We have lost several techs to the crosstown private hospital. When it happens, the slides start coming out later and basically throws a wrench into the entire system. Thankfully, the dept has been fairly quick in hiring replacements, but those transition weeks can be painful.

 

[cjw0918]

Cam, How many big cases do you usually have to preview and sign out and does sign out start at the same time everyday?

 

[CameronFrye]

Cam, How many big cases do you usually have to preview and sign out and does sign out start at the same time everyday?

The start of signout can vary somewhat depending on the conference schedule and the attending. For example, one of our prominent attendings likes to roll in around 10:30 (but he's so fast, you still finish up pretty early).

I wasn't sure of the numbers off the top of my head, so I did a search of our database. As a first year, I signed out 1800 surgicals in 5 months (360/month). That number includes smalls and mains. It looks like my mains signouts usually consisted of 30 to 50 cases. Some of the cases were massive and I spent an hour previewing, others took 30 seconds to preview. It depends on what services are operating on your grossing day.

Here are two random signouts from my first year:

32 cases: 1 Whipple, 1 tibia resection for osteosarc, 1 osteochondroma resection, 1 neck dissection, 1 flank mass, 2 lumpectomies, 1 SB resection for perf, 1 omentectomy for metastatic sarcomatiod carcinoma (the curative procedure was aborted), 1 lung wedge biopsy, 1 uterus for POP, 3 gallbags, 1 appy, 1 neuroblastoma resection, 1 total thyroid, 2 placs, 2 tah-bso’s, 2 lobectomies for tumor, 1 partial vulvectomy, 1 partial thyroid, 1 staging mediastinoscopy, 1 radical prostatectomy, 1 liver explant with multifocal HCC, 1 spermatic cord mass resection, 1 axillary lymph node dissection, 2 hernia sacs.

47 cases: 2 gallbags, 1 radical nephrectomy with IVC resection, 1 sentinel nodes, 3 tah-bso’s, 1 lobectomy for tumor, 1 partial nephrectomy, 2 total thyroids, 1 atrial myxoma, 1 hemicolectomy/small bowel resection/partial bladder resection, 4 placs, 1 parathyroid, 1 endarterectomy, 1 cholesteatoma, 1 thymectomy, 1 splenectomy, 1 resection of endobronchial tumor, 1 lumpectomy, 1 wide excision of left flank melanoma with sentinel nodes, 1 cyst excision, 1 bilateral fibroadenoma resection, 2 lipomas, 3 mastectomies, 2 colectomies, 1 appy, 1 resection of orbital/lacrimal gland lesion, 2 adrenalectomies, 1 supraclavicular mass, 1 partial colectomy/splenectomy, 1 stoma, 1 achilles tendon, 1 bone spur, 1 tongue resection, 1 vaginal mass/partial colectomy/SB resection, 1 esophagogastrectomy, 1 loose body

Hope that helps.

 

[cjw0918]

The start of signout can vary somewhat depending on the conference schedule and the attending. For example, one of our prominent attendings likes to roll in around 10:30 (but he's so fast, you still finish up pretty early).

I wasn't sure of the numbers off the top of my head, so I did a search of our database. As a first year, I signed out 1800 surgicals in 5 months (360/month). That number includes smalls and mains. It looks like my mains signouts usually consisted of 30 to 50 cases. Some of the cases were massive and I spent an hour previewing, others took 30 seconds to preview. It depends on what services are operating on your grossing day.

Here are two random signouts from my first year:

32 cases: 1 Whipple, 1 tibia resection for osteosarc, 1 osteochondroma resection, 1 neck dissection, 1 flank mass, 2 lumpectomies, 1 SB resection for perf, 1 omentectomy for metastatic sarcomatiod carcinoma (the curative procedure was aborted), 1 lung wedge biopsy, 1 uterus for POP, 3 gallbags, 1 appy, 1 neuroblastoma resection, 1 total thyroid, 2 placs, 2 tah-bso’s, 2 lobectomies for tumor, 1 partial vulvectomy, 1 partial thyroid, 1 staging mediastinoscopy, 1 radical prostatectomy, 1 liver explant with multifocal HCC, 1 spermatic cord mass resection, 1 axillary lymph node dissection, 2 hernia sacs.

47 cases: 2 gallbags, 1 radical nephrectomy with IVC resection, 1 sentinel nodes, 3 tah-bso’s, 1 lobectomy for tumor, 1 partial nephrectomy, 2 total thyroids, 1 atrial myxoma, 1 hemicolectomy/small bowel resection/partial bladder resection, 4 placs, 1 parathyroid, 1 endarterectomy, 1 cholesteatoma, 1 thymectomy, 1 splenectomy, 1 resection of endobronchial tumor, 1 lumpectomy, 1 wide excision of left flank melanoma with sentinel nodes, 1 cyst excision, 1 bilateral fibroadenoma resection, 2 lipomas, 3 mastectomies, 2 colectomies, 1 appy, 1 resection of orbital/lacrimal gland lesion, 2 adrenalectomies, 1 supraclavicular mass, 1 partial colectomy/splenectomy, 1 stoma, 1 achilles tendon, 1 bone spur, 1 tongue resection, 1 vaginal mass/partial colectomy/SB resection, 1 esophagogastrectomy, 1 loose body

Hope that helps.

Wow, Cam. Thanks for the input. I'm truly jealous of your sign-out experience. I probably have around the same # of bigs/sign out, but I don't have near the variety. Most of my bigs are breast, prostate, lung, or kidney with a few gallbladders, appys, hernia sacs, and way too many placentas thrown in. (We process ALL placentas- arghhhhhh.) How in the world do you preview all this stuff, write it up with synoptic reports, and bill it all before sign out the next day?

 

[DarksideAllstar]

Here are two random signouts from my first year:

32 cases: 1 Whipple, 1 tibia resection for osteosarc, 1 osteochondroma resection, 1 neck dissection, 1 flank mass, 2 lumpectomies, 1 SB resection for perf, 1 omentectomy for metastatic sarcomatiod carcinoma (the curative procedure was aborted), 1 lung wedge biopsy, 1 uterus for POP, 3 gallbags, 1 appy, 1 neuroblastoma resection, 1 total thyroid, 2 placs, 2 tah-bso’s, 2 lobectomies for tumor, 1 partial vulvectomy, 1 partial thyroid, 1 staging mediastinoscopy, 1 radical prostatectomy, 1 liver explant with multifocal HCC, 1 spermatic cord mass resection, 1 axillary lymph node dissection, 2 hernia sacs.

47 cases: 2 gallbags, 1 radical nephrectomy with IVC resection, 1 sentinel nodes, 3 tah-bso’s, 1 lobectomy for tumor, 1 partial nephrectomy, 2 total thyroids, 1 atrial myxoma, 1 hemicolectomy/small bowel resection/partial bladder resection, 4 placs, 1 parathyroid, 1 endarterectomy, 1 cholesteatoma, 1 thymectomy, 1 splenectomy, 1 resection of endobronchial tumor, 1 lumpectomy, 1 wide excision of left flank melanoma with sentinel nodes, 1 cyst excision, 1 bilateral fibroadenoma resection, 2 lipomas, 3 mastectomies, 2 colectomies, 1 appy, 1 resection of orbital/lacrimal gland lesion, 2 adrenalectomies, 1 supraclavicular mass, 1 partial colectomy/splenectomy, 1 stoma, 1 achilles tendon, 1 bone spur, 1 tongue resection, 1 vaginal mass/partial colectomy/SB resection, 1 esophagogastrectomy, 1 loose body

Hope that helps.

I'm making the assumption that there were PAs involved in grossing part of your case load?

 

[CameronFrye]

Wow, Cam. Thanks for the input. I'm truly jealous of your sign-out experience. I probably have around the same # of bigs/sign out, but I don't have near the variety. Most of my bigs are breast, prostate, lung, or kidney with a few gallbladders, appys, hernia sacs, and way too many placentas thrown in. (We process ALL placentas- arghhhhhh.) How in the world do you preview all this stuff, write it up with synoptic reports, and bill it all before sign out the next day?

I do like the variety and that's why I preferred to go to a place with general signout. That being said, I think subspecialty services enable you to focus your reading better and you get the benefit of signing out with an "expert" in that field everyday. I definitely think both setups have their pros and cons.

OB only sends us placentas for complicated pregnancies or multiple births, so that keeps our numbers down of those.

As for previewing everything, there were definitely some rough days early on, but by the end of the year I was a lot more efficient. Also, as a first year, I didn't pre-dictate too many cases until the end of the year (although I would fill out synoptics on every case that required them). When I return to service as a 3rd year, I'll probably pre-dictate everything, so that will slow down previewing (but speed up the next day's signout).

 

[CameronFrye]

I'm making the assumption that there were PAs involved in grossing part of your case load?

Yes, there was a PA who helped, especially with the ditzel cases. The frozen resident will usually pitch in some too. However, I usually grossed in most of the big cases by myself (well, except for the LN searches). Our tissue processors start at 8 each evening, so that gives you 8 to 10 hours to finish everything. You can gross in a ton of stuff in that amount of time (although most people finished up well before 8. I'm just somewhat deliberate).

The gross room now has a second PA, so I've heard that the grossing days are a piece of cake now.

 

[yaah]

The "subspecialty signout vs general signout" topic has been discussed extensively before. My general impression is that whichever one that people are comfortable with that is the one they will defend (often vociferously) and give many reasons as to why the other is less preferable. I have done both and I like subspecialty, but only if you have sufficient volume to make it useful. Both can be effective for different reasons.

Our program, for example, has too much volume to have a service run like that described above. The ORs will often on busy days put out 2 Whipples, 3-4 Colons, a liver, an esophagus, 2 lungs, 5-6 thyroids, a sarcoma, multiple large head and neck commando resections, up to 10 uterus/ovary cases, 3-4 prostates, 1-2 bladders, a couple of kidneys, 7-8 breast cases, etc etc. So instead biopsies are combined with large specimens into one signout.

 

[cjw0918]

I do like the variety and that's why I preferred to go to a place with general signout. That being said, I think subspecialty services enable you to focus your reading better and you get the benefit of signing out with an "expert" in that field everyday. I definitely think both setups have their pros and cons.

OB only sends us placentas for complicated pregnancies or multiple births, so that keeps our numbers down of those.

As for previewing everything, there were definitely some rough days early on, but by the end of the year I was a lot more efficient. Also, as a first year, I didn't pre-dictate too many cases until the end of the year (although I would fill out synoptics on every case that required them). When I return to service as a 3rd year, I'll probably pre-dictate everything, so that will slow down previewing (but speed up the next day's signout).

I wish we dictated cases after sign-out here. We have everything written up and ready for transcription before sign out. When we rotate at the VA we dictate after sign-out and I feel it is much more efficient. I'd rather spend my preview time reading around my cases and looking at them rather than putting together paperwork and handwriting diagnoses/comments. I have gotten more efficient at previewing over time, but I still feel very rushed when I have a heavy sign out. And then I miss things and hear about it from the attending. 🙁
I agree with yaah on subspecialty vs. gen S/O. We don't have the volume for subspecialty S/O (only 13K specimens/yr), but I often wish we did so I could learn from some folks with expertise in certain fields, like GI and GU. I also worry that my exposure to GYN and derm is so limited that I won't be competent in these areas. Seems like a lot of places, general SP sees enough derm and GYN to at least give you a solid foothold in the basics of these topics. I feel like a SP fellowship would be a good idea, but I'm already doing cyto and really don't want to do another f/s. Thanks for replies.

 

[DarksideAllstar]

Yes, there was a PA who helped, especially with the ditzel cases. The frozen resident will usually pitch in some too. However, I usually grossed in most of the big cases by myself (well, except for the LN searches). Our tissue processors start at 8 each evening, so that gives you 8 to 10 hours to finish everything. You can gross in a ton of stuff in that amount of time (although most people finished up well before 8. I'm just somewhat deliberate).

The gross room now has a second PA, so I've heard that the grossing days are a piece of cake now.

Ah, well that explains at least part of it. A lot of those cases would typically include LN hunts and I was about to be very impressed if you did them all yourself (back in the day on AP here we would have to do all the LNs that came with each specimen ourselves... not sure if thats changed within the last two years since I was last on surgicals though).

I also agree with your comment re: reading in a subspecialty vs general s/o program. At the beginning I felt completely schizophrenic having to jump from GYN to thyroid to GI in Sternberg. So instead each week I would focus on learning about the basic stuff of a particular subspec (ie GI) and then throughout my sign outs I would pick and choose interesting things that I saw in other systems to learn a little more about.

 

[CameronFrye]

The "subspecialty signout vs general signout" topic has been discussed extensively before. My general impression is that whichever one that people are comfortable with that is the one they will defend (often vociferously) and give many reasons as to why the other is less preferable. I have done both and I like subspecialty, but only if you have sufficient volume to make it useful. Both can be effective for different reasons.

Our program, for example, has too much volume to have a service run like that described above. The ORs will often on busy days put out 2 Whipples, 3-4 Colons, a liver, an esophagus, 2 lungs, 5-6 thyroids, a sarcoma, multiple large head and neck commando resections, up to 10 uterus/ovary cases, 3-4 prostates, 1-2 bladders, a couple of kidneys, 7-8 breast cases, etc etc. So instead biopsies are combined with large specimens into one signout.

Agreed. Mich has twice our volume and more residents, so a subspecialty system makes sense.

In our system, one resident gets every case that day (excluding derm, medical kidney, and neuro). That's obviously not feasible at a higher volume place.

 

[Logos']

...

 

[pathstudent]

As Yaah stated, the debate between general and subspecialty sign out has been well described and I will not further address it accept to say that very few programs have truly general sign out ... so really it is degrees of subspecialization that one must choose from.

.

I would define general sign-out as where specimens from the OR are divied up among the residents regardless of organ/subspecialty and the residents have a 2-3 day schedule for grossing/previewing and signing out.

Subspecialty is where the residents are assigned specimens solely based on organ/subspecialty and they gross/signout/preview on a 1 day schedule.

I think those definitions will separate most programs into two sets with a few places (like Michigan based on what has been stated) in the intersection of that venn diagram.

The vast majority of programs have general sign-out. I interviewed at over a dozen "big name" programs, and I think only 2-3 of them had subspecialty sign-out, at least as of a few years ago.

 

[CameronFrye]

I would define general sign-out as where specimens from the OR are divied up among the residents regardless of organ/subspecialty and the residents have a 2-3 day schedule for grossing/previewing and signing out.

Subspecialty is where the residents are assigned specimens solely based on organ/subspecialty and they gross/signout/preview on a 1 day schedule.

I think those definitions will separate most programs into two sets with a few places (like Michigan based on what has been stated) in the intersection of that venn diagram.

The vast majority of programs have general sign-out. I interviewed at over a dozen "big name" programs, and I think only 2-3 of them had subspecialty sign-out, at least as of a few years ago.

Yeah, I would agree with your definition. The one confounding program would probably be CCF. It's general in that the grossing resident takes all comers, but it's subspecialty in that you sign out each specialty with a different attending.

 

[djmd]

Yeah, I would agree with your definition. The one confounding program would probably be CCF. It's general in that the grossing resident takes all comers, but it's subspecialty in that you sign out each specialty with a different attending.

I thought that their grossing was divided in to clusters so one resident grossed all GI and some other things, and second grossed all GYN (plus others), and a third did GU+...

I guess that is different than some subspecialty in that your don't gross only one organ system, but the sign out is essentially subspecialty.

 

[Logos']

...

 

[CameronFrye]

I thought that their grossing was divided in to clusters so one resident grossed all GI and some other things, and second grossed all GYN (plus others), and a third did GU+...

I guess that is different than some subspecialty in that your don't gross only one organ system, but the sign out is essentially subspecialty.

That may be true. It's been a couple years since I visited there, so I probably don't remember all of the details.

 

[pathstudent]

Well that definition does not work exactly, at UCSF for example, neurosurgical specimens that come up from the OR are signed out the next day with a neuropathologist, not with the rest of the specimens signed out on day 3, though we still consider ourselves to have "general sign out."

I see what you are saying, NP is likely subspecialized at any program where they have neuropathologists. But is there a resident who only gets the NP specimens for a week or two weeks or a month? That's what I think people mean by specialized sign-out for the residents. (the resident only focuses on a limited area for a designated rotation).

 

[sickofit]

Yeah, I would agree with your definition. The one confounding program would probably be CCF. It's general in that the grossing resident takes all comers, but it's subspecialty in that you sign out each specialty with a different attending.

CCF doesn't have the residents grossing in all comers. Grossing is kind of "hybrid" subspecialty where there are three different benches and each bench has a certain number of organ systems. Then you signout each of those organ systems during signout one system at a time with an expert from each. So you see a few systems at a time, but it's definitely not the tradition general set-up nor is it truly subspecialized a la brigham/mgh and others.

 

[CameronFrye]

CCF doesn't have the residents grossing in all comers. Grossing is kind of "hybrid" subspecialty where there are three different benches and each bench has a certain number of organ systems. Then you signout each of those organ systems during signout one system at a time with an expert from each. So you see a few systems at a time, but it's definitely not the tradition general set-up nor is it truly subspecialized a la brigham/mgh and others.

Ok, thanks for the clarification.