Pgy1

[alaska82]

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Hi Friends,

I wanted to know what are the expectations on PGY1s during signout. Their responsibility in frozen room, grossing specimens. To what extent we can take help from seniors or attendings?

Thanks

 

[gbwillner]

Hi Friends,

I wanted to know what are the expectations on PGY1s during signout. Their responsibility in frozen room, grossing specimens. To what extent we can take help from seniors or attendings?

Thanks

During signout you are expected to know nothing. There will be pimping but mostly straight-up teaching. Don't worry- it takes time to get a hang of things.
We don't let 1st years do frozens at my program... but it's really not that bad. It's mostly common sense to take the right sections and you pick it up quickly. You WILL be doing a lot of grossing... but it's a monkey job that really takes a month or so to pick up well. There are subtle variations for different specimens but really the concept is always the same- describe what you see, sample adequately, get margins.
You shouls expect a lot of help from attendings and senior residents. If you don't get it you went to the wrong program.

 

[gschl1234]

Hi Friends,

I wanted to know what are the expectations on PGY1s during signout. Their responsibility in frozen room, grossing specimens. To what extent we can take help from seniors or attendings?

Thanks

At our program there is no difference in expectation between PGY1 and others for frozens and grossing. Although if a PGY1 is really in trouble, the senior grossing on the same day will bail them out. For sign out, the expectations are much lower for PGY1 in their first month than others.

 

[TinyFish]

I think it depends. I mean, we're not expected to know much at all, but I wouldn't say we're expected to know "nothing." I definitely have had attendings during my first month and a half who have point blank treated me like I'm making the diagnosis. I mean, if we get it wrong, which obviously we are going to be many times, it's a learning opportunity and no one makes you feel bad about it. It's generally unacceptable to sit back and not try. I have learned the most from attendings who make me sweat it out.

To more directly answer your question, it probably varies by program. Here, in general, we are expected to know the clinical history, be familiar with the gross findings in each case, know normal histology, patterns of injury in each tissue, and most common disease processes and neoplasms associated with each organ system. In terms of frozens, we get trained and help is always available; we're responsible for receiving and grossing. If on call, we accession, gross, cut, and stain.

In terms of grossing...well, it doesn't take long to get used to general grossing skills and some specifics, but it takes longer to become familiar with gross-histologic correlations.

 

[KCShaw]

Definitely varies by program.

At different programs I was at: the smaller program theoretically assigned PGY1's to an attending who taught basic grossing but generally didn't bother teaching how to do a frozen; in practice the PA taught grossing & how to set up (cut, freeze, put on a slide, and stain) frozens. For the most part, attendings did this literally behind our backs -- if we didn't know a frozen had been brought in, the room was so noisy sometimes you'd look back over your shoulder and see a surgeon sitting there looking at a frozen with your attending without them ever notifying you - we complained enough that this was slowly changing. There were minimal signout expectations beyond writing down diagnoses the attendings spouted. The program was so small, however, that it was often difficult to find a free and willing senior or attending to get advice from, though the PA kept us out of trouble in the gross room if we bothered to listen or ask.

At the other, mid-sized, program PGY1's were assigned to a senior resident for a month (maybe it was 2 weeks?), and the senior's job was to ensure they were able to function on their own by the end of that time -- grossing all the common specimens, setting up frozens (for juniors, attendings usually liked to be in the room; seniors would usually notify the attending what it was, confirm how they were grossing it/sample being taken, and have a stained slide ready by the time the attending walked in), previewing and pre-ordering the most basic/"required" stains, and knowing who to ask what and when. The program was just large enough that it usually wasn't difficult to find a senior or a free and willing attending to get some advice from after that (though some of the attendings were SO far removed from grossing that asking them about it was...unwise; others were very good). Signout responsibilities included having SOMETHING written for each case, and progressively being able to dictate diagnoses in efficiently; some attendings pushed harder and expected more than others, but as long as you showed effort and improvement it wasn't too bad.