Pathology Prelim year?!?

[kingbug]

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A friend/classmate is going into path, but he wants to do a prelim year in medicine to broaden his clinical knowledge and experience in order to be a better pathologist. He is not applying to any path programs. I know for other specialties like radiology, the match provides a prelim match and a desired specialty match the following year. The questions are:

1. Should he apply to path programs as well and inform them of his desire to do a prelim year? Can path prgms pre-match for the following year?

2. Can programs help match a prelim in the same hospital and have a silent agreement of matching the following year?

3. What is the general view of an applicant doing a prelim year?

Please help... your opinions will be greatly appreciated!

 

[djmd]

Your friend/classmate/you is crazy.

I don't know of any pathology programs that do something like that. Not officially...

2. See 1, possible but unlikely.

3. prelim for pathology? Crazy. If you didn't know what you wanted to do, maybe but just to be more well rounded? Hell do your well rounding in fourth year. Do extra AIs if you want...

 

[gbwillner]

I actually went through a similar phase. I wanted to do a prelim year for several reasons. Such a year used to be mandatory long ago, and I thought it was silly that it went from being mandatory to not at all an option unless you want to go through the match twice.
Several faculty members in CP strongly encouraged it, as some feel that PGY1 residents don't have enough background clinical knowledge. Others thought it was a waste of time and recommended adding another fellowship instead. It really does nothing to advance your career and only shortens it by one year.
I started asking around, and most programs won't let you do it. In part it is because of funding. you get 4 years of funding at your training hospital. If you're AP/CP, and you spend a year doing medicine, then the department will have to pay for your final year of training.
Many programs will also look down on you for doing this. They may think you are not serious about pathology or just confused. If you decide to go through the match twice, or apply for path outside the match, this again hurts your application.
Your friend could still do some clinical medicine during his/her elective time. I've spoken with programs about this, and they tend to see this in the right light- that you are interested in the whole picture and not just confused.

 

[CameronFrye]

It's a ridiculously bad idea. Any benefit that would be gained would be too minimal to make up for the lost year. Heck, use that year to do an extra path fellowship.

On a more practical note, your friend should look into how this could affect his future funding to do path. Someone can correct me if I'm wrong, but I believe the govt will only fund your residency position for a certain amount of years. This is usually more of an issue when switching residencies, but may come into play here. I'm not completely sure though, so someone with more knowledge needs to chime in.

 

[CameronFrye]

bgwillner beat me to the punch, but that's what I thought.

 

[yaah]

Is it really going to make you a better pathologist? I know pathologists who did other residencies beforehand. It doesn't necessarily make them better pathologists.

It doesn't really make sense. What is the overarching goal? You become a better pathologist by devoting yourself to your career and your training. I think the better plan would be to do pathology and then see if you still want to do a year of medicine or surgery. You don't become a better pathologist by spending a year doing floor work and the like or assisting in surgeries. You may "understand" more what these physicians go through, but what advantage does it give you? You can understand what is important to clincians (like appreciating the clinical history, timely and detailed reports, etc) without going through all that.

The reasons they eliminated the prelim year for path is that it isn't necessary and no one was really doing it.

 

[bellgirl]

If you/your friend enjoy(s) being a vitals monkey and paperwork b&@#h--and really dislike(s) sleeping in your own beds--by all means, do that internship and learn nothing while delaying your future earning power one year. Please.

 

[mlw03]

let's try not to be too harsh, ya'll. i'm about to graduate med school and there's a lot of clinical medicine i don't know yet, nor will i ever. there is some legitimacy to the argument that transitional or prelim IM year would give the future pathologist more clinical knowledge. now will that ultimately affect my ability to perform the job of a pathologist? probably not, especially for AP. but the idea that the year would be a total waste is probably a little extreme.

i do agree with the assessment that it's simply not doable to apply twice. interviewing during an internship year would be hard, and i doubt any program is going to be more impressed by an applicant who's done clinical medicine. and that's on top of the funding issues discussed.

so while it sounds like we all agree it's a bad idea given the current reality, to say that a year of clinical medicine would be completely useless is just going a bit too far in my opinion.

 

[malchik]

You could do your residency in Canada, where I believe prelim years are still required.

 

[raspberry009]

Well think of it this way... he'll be prepared for his step 3..

 

[b&ierstiefel]

Doing a prelim year may help you appreciate the role of pathology and the impact it has on patient care. For example, how long does the team have to wait until they decide to bug the pathologist for a prelim dx. That being said, floor work operates under a very different mentality where pathology is actually seldomly mentioned. Heme/Onc may be an exception.

It is important to have a sound clinical fund of knowledge since pathologists are in the position to synthesize clinical information with pathologic findings to come to the most appropriate diagnosis. But I think doing a prelim year is overkill and would easily satisfy the "law of diminishing returns."

So I wouldn't recommend doing a prelim year. I wouldn't think badly of you if you were to do one either.

 

[kingbug]

Thanks for all the input... My friend hadn't heard about the possible funding complications, so he looked into it further. He's still set in applying to only prelim programs. I tried to convince him to apply to a few path programs as a backup plan.

Thanks again!

 

[yaah]

If he really wants to do pathology then most people would say he/you is making a mistake by doing that. It probably decreases chances of matching at better programs. But should definitely get advice on that from med school deans, path attendings, etc. If he is conflicted over what the best career path is (and whether or not it includes pathology) then a prelim year is a good choice.

 

[malchik]

Why would you nullify one of the strongest reasons to do a pathology residency?