Procedures/physical requirements in path?

[biogirl215]

---

Members don't see this ad.

Hi,
I've read the FAQs and all but can't seem to find a clear answer to my question, so I fiigured I'd ask here.

Besides the autopsies in AP (which I understand as fairly minimal), what other physical requirements/procedures are done in path? I thought of preparing slides and samples, but then I read that techs and assistants do that, not attendings or residents. True? What other physical requirements and procedures exist in path?

Thanks.

 

[sohsie]

Hi,
I've read the FAQs and all but can't seem to find a clear answer to my question, so I fiigured I'd ask here.

Besides the autopsies in AP (which I understand as fairly minimal), what other physical requirements/procedures are done in path? I thought of preparing slides and samples, but then I read that techs and assistants do that, not attendings or residents. True? What other physical requirements and procedures exist in path?

Thanks.

1) Autopsies
2) Grossing surgical specimens (Can require standing for many hours working with hands
3) Performing frozen sections (Stand over cold microtome and cut thin frozen sections, stain)
4) Fine needle aspirations
5) Bone marrow biopsies (can be physically demanding)

You dont have to prepare slides (except for frozen sections). Histotechs do that.

I dont think I missed anything.

 

[l&usibari]

Enough manual dexterity to be able to drive the scope and handle slides. And I'm serious too--I imagine it can be difficult/painful for someone with arthritis, carpel tunnel, or another disorder that affects the hands.

 

[yaah]

There are many pathologists, of course, who don't do bone marrows or FNAs. And oftentimes, techs cut the frozens. As a resident you will almost assuredly have to do several FNAs and numerous frozens though. Bone marrows, it varies. I haven't done any.

 

[EtOHWithdrawal]

I don't mean to hijack the thread, but it caught my interest when yaah said he hasn't done any bone marrows...
How many procedures do you need for registration for the boards? No one can seem to tell me exact figures except for autopsies (50).
ie FNA's, Bone marrows, surgical specimens, cytology specimens, etc., etc.
even just a link would be fantastic.

EtOH

 

[mlw03]

EtOH - i've heard 6 bone marrow's required, but i don't think you have to do them yourself, just observe. not sure if that's true, but it's been the number i've heard a few times from PDs.

biogirl, is there a specific reason you're asking? if so, by stating it you'll get a more specific answer. obviously path doesn't involve the dexterity required of surgeons, but certainly more than psychiatry.

 

[b&ierstiefel]

I don't mean to hijack the thread, but it caught my interest when yaah said he hasn't done any bone marrows...
How many procedures do you need for registration for the boards? No one can seem to tell me exact figures except for autopsies (50).
ie FNA's, Bone marrows, surgical specimens, cytology specimens, etc., etc.
even just a link would be fantastic.

EtOH

I'm not aware of any such requirement regarding bone marrow biopsies. The oncologists at our hospital do them...not pathologists. If we had to actually perform some to sit for boards, we would not graduate any board certified pathologists. The 50 autopsy requirement is the most quoted one for boards. I know a certain number of FNAs are required but the exact number I'm not aware of. If I find out, I'll get back to you. As for surgical specimens and cytology specimens, yes we have to give the ABP a count when we register for boards...not sure if there is a minimum cutoff. There may be a minimum requirement but again, I don't know the exact number.

 

[sohsie]

EtOH - i've heard 6 bone marrow's required, but i don't think you have to do them yourself, just observe. not sure if that's true, but it's been the number i've heard a few times from PDs.

biogirl, is there a specific reason you're asking? if so, by stating it you'll get a more specific answer. obviously path doesn't involve the dexterity required of surgeons, but certainly more than psychiatry.

Currently, there are no requirements except for 50 autopsies, although they do ask you on your board app how many bone marrow biopsies, FNAs, surgicals, clinical consults and probably something else Im not thinking of. I think they are just gathering data. There are no stated number requirements for anything but autopsy.

 

[mlw03]

Currently, there are no requirements except for 50 autopsies, although they do ask you on your board app how many bone marrow biopsies, FNAs, surgicals, clinical consults and probably something else Im not thinking of. I think they are just gathering data. There are no stated number requirements for anything but autopsy.

thanks for that info - i stand (sit) corrected.

 

[yaah]

Yes, there are no requirements for bone marrows. The boards application asks you how many you have done. But I put zero. I don't think you are required to do any FNAs either. The boards also asks you how many surgical specimens you signed out and how many "clinical consults" you did (both end up being guesses unless you want to spend hours trying to figure it out).

You have to do bone marrows in hemepath fellowships I believe, but it might only be 3. Some programs may have requirements of their own.

The boards lists
1) How many autopsies did you do? (attach a list with date of case, cause of death, age of patient listed) It also asks you how many were forensic, shared, and limited, although you are not required to list these details on the separate list. Basically, I think your program director signs off on it. So if your program director is willing to certify you for doing 25 forensic cases and 20 shared autopsies, that would probably be ok. Our program had a requirement that not more than 10 be forensic and not more than 10 be shared, I am not sure if that is still a requirement.

2) How many FNAs did you perform? (just a number, no separate list or "proof" is required)

3) How many bone marrows?

4) How many surgical specimens? (I put 13000 after many estimates, which the program director thought might be a bit high, but then again I tend to see more cases than most other residents)

5) How many cytopath specimens did you see (not just FNAs). I think I put 800-900, but again, there is no requirement.

6) How many clinical consults? (They define this loosely as talking with clinicians about a case, like a platelet approval or whatever).

7) They ask you to say how many months you spent on each branch of AP and CP (like cytopath, pediatric path, forensic path, blood bank, hematopath, etc).

Basically, I think they trust the program director to ensure you are telling the truth.

 

[EtOHWithdrawal]

Thanks for the replies. Good news, truly.

 

[katrina]

You must do 50 autopsies for your AP Board certification- not exactly minimal. In some programs it is difficult to achieve this goal. Other physical requirements include grossing surgical pathology specimens, frozen sections, fine needle aspirations and specimen adequacy checks for interventional radiology procedures, and bone marrow biopsies. All programs, as far as I know ask you to keep an official record of the number and types of these interventions/assessments.

 

[l&usibari]

All programs, as far as I know ask you to keep an official record of the number and types of these interventions/assessments.

While they should, some programs wait til you are a couple years into residency then say, "and by the way, I hope you have all been keeping a list of your FNAs, bone marrow biopsies, CP calls, surgical and cytology specimens!". And then you say "doh".

 

[jux]

4) How many surgical specimens? (I put 13000 after many estimates, which the program director thought might be a bit high, but then again I tend to see more cases than most other residents)

Does it matter for this number if you gross them or just look at the glass?

 

[DrBloodmoney]

Does it matter for this number if you gross them or just look at the glass?

We only report the ones where our name is actually on the final report. It was 4000 for me. At our program this is a very low representation of the total cases that we are involved in because there are many many cases where our names don't get included in the final (primarily due to our ****ty lazy transcription service). I think ABP recommends >2000 surgicals.

 

[sohsie]

I had a hard count of FNAs and Bone Marrow biopsies because our program requires you to log them into the ACGME website (I think I logged in the FNAs. I know I logged in the bone marrow biopsies.

The others, I basically did some wild guestimations. Alcohol helps in this regard Dont stress over it, just plug in some numbers.

 

[LADoc00]

Interestingly, I argued with my residency program when they claimed I needed to perform 15 marrows for board cert...there really is no such requirement. 2 words: Urban legend

 

[biogirl215]

biogirl, is there a specific reason you're asking? if so, by stating it you'll get a more specific answer. obviously path doesn't involve the dexterity required of surgeons, but certainly more than psychiatry.

Why, yes, there is... Thanks for asking! 🙂 I'm working with a large array of physical limitations and trying to see if I could actually function in any field of medicine. Path seemed like one of the ones that could be a possibility, so I wanted to get a feel of what procedures would be required in the field.

Your answers have all been very helpful, by the way, so thanks. 🙂

 

[mlw03]

Why, yes, there is... Thanks for asking! 🙂 I'm working with a large array of physical limitations and trying to see if I could actually function in any field of medicine. Path seemed like one of the ones that could be a possibility, so I wanted to get a feel of what procedures would be required in the field.

Your answers have all been very helpful, by the way, so thanks. 🙂

with what you note above, pathology might be difficult. autopsies and grossing require you to have a fair amount of dexterity, as do handling frozen sections. however a CP only residency and career might still be an option, but perhaps there is some part of CP i don't yet know about that requires some hands-on skills. psychiatry, in my opinion, is the specialty involving the least amount of physicality. pure diagnostic radiology is another option.

there's an episode of ER that deals with this. don cheadle plays a med student with parkinsonism and he has to promise corday he'll go into psych or radiology after his tremor hurts a few patients. the ADA obviously protects such people from discrimination, but the reality is that anything aside from psych or diagnostic radiology would be pretty tough to do with a severe physical limitation.

 

[alois]

Rather than quoting television shows, it is useful to look at the actual data (sort of EBM). The document most medical schools use as the starting point for consideration of disabilities is the "Recommendations of the AAMC Special Advisory Panel on Technical Standards for Medical School Admission" (dig into their websites and this is what you will find).

Among other things, this document includes the following statements:

• The M.D. degree is, and must remain, a broad, undifferentiated degree attesting to the acquisition of general knowledge in all fields of medicine and the basic skills requisite for the practice of medicine
• A candidate for the MD degree must have abilities and skills in five varieties, including observation; communication; motor; conceptual, integrative, and quantitative; and behavioral and social. Technological compensation can be made for some handicaps in certain of these areas, but a candidate should be able to perform in a reasonably independent manner. The use of a trained intermediary means that a candidate’s judgment must be mediated by someone else’s power of selection and observation.
• A candidate should be able to execute motor movements reasonably required to provide general care and emergency treatment to patients. Examples of emergency treatment reasonably required of physicians are cardiopulmonary resuscitation, the administration of intravenous medication, the application of pressure to stop bleeding, the opening of obstructed airways, the suturing of simple wounds, and the performance of simple obstetrical maneuvers. Such actions require coordination of both gross and fine muscular movements, equilibrium, and functional use of the senses of touch and vision.
• A candidate must be able to observe a patient accurately at a distance and close at hand. Observation necessitates the functional use of the sense of vision and somatic sensation.

Finally, in nearly every state there is a requirement for reporting of impaired physicians by other health professionals. While this is usually interpreted as covering drug or alcohol problems, it does include all possible limitations on the ability to practice (medical, cognitive, physical, etc). As a recent letter to the editor in the New York Times shows, this can be a difficult decision sometimes exposing "whistle blowers" to lawsuits (http://www.nytimes.com/2007/12/29/opinion/l29doctors.html).

Separately, on the question of how many of a certain procedure is "required" -- we need to be clear WHO the requiring body is.

• In order to sit for the boards (the American Board of Pathology requirements), the only current absolute requirement of specific tasks is 50 autopsies (down from 75 not that long ago). The other requirements deal with time in training in an ACGME-accredited program.
• When the Pathology RRC inspects training programs in order to accredit them, it asks lots of questions about how many specimens residents see, how many FNAs they perform, how many bone marrow biopsies they perform. This information, which is submitted by the program in written form, is checked by interviews with residents and faculty during the site visit. The intention is to ensure that trainees complete residency with an adequate exposure to pathology across the board. Because this is handled by the ACGME, the ABP doesn't (apparently) feel the need to mix in.

Bottom line for both types of questions: DATA trumps "my friend told me"/"I saw it on television"/"I heard that"

 

[mlw03]

what data have you provided, aside from the 50 autopsy requirement that's already been mentioned? this person asked about physical requirements for a pathology residency, not those required to obtain the MD. our answers assume the poster is able to obtain their MD. i'm not sure what kind of data there is to answer the question, so we're just having a discussion on the topic. so your DATA can trump my mentioning how this topic was addressed on a popular TV show. i'm just trying to have a conversation - not do big time evidenced based medicine - here on SDN.

 

[yaah]

Most of the technical requirements do not really apply to residencies, though, as far as I can tell. It is the responsibility of the medical school that grants the M.D. to certify that the graduate is technically proficient, not the residency that takes them in. So I would posit that if your disabilities are such that you can make it through med school, a residency would not be a problem at all.

So what I would do is direct your question towards someone experienced in med school administration, because that is the first hurdle you would have to overcome. I remember my med school's technical standards including things like being able to get from one place to another quickly in response to emergency. Part of technical standards include communication and observation, but the motor part would be relevant here

III. Motor: Candidates should have sufficient motor function to elicit information from patients by palpation, auscultation, percussion, and other diagnostic maneuvers. A candidate should be able to do basic laboratory tests (urinalysis, CBC, etc.), carry out diagnostic procedures (proctoscopy, paracentesis, etc.), and read EKGs and x-rays. A candidate should be able to execute motor movements reasonably required to provide general care and emergency treatment to patients. Examples of emergency treatment reasonably required of physicians are cardiopulmonary resuscitation, the administration of intravenous medication, the application of pressure to stop bleeding, the opening of obstructed airways, the suturing of simple wounds, and the performance of simple obstetrical maneuvers. Such actions require coordination of both gross and fine muscular movements, equilibrium, and functional use of the senses of touch and vision.

I have known med students in wheelchairs and even one with a single arm, so I think reasonable accomodations are often made.

 

[mlw03]

I have known med students in wheelchairs and even one with a single arm, so I think reasonable accomodations are often made.

there's a PGY2 at my school who also got her MD here, and she only has a left arm to just distal to the elbow joint. she has a prosthetic distal arm and hand. i worked with her during my IM rotation, and she was not at all slowed down by this (it's congenital i think, so she's learned to adapt well). she was able to type and write notes at normal speed, although i never saw her try to do any procedures. and guess what specialty she's gone into? - diagnostic radiology. i didn't know her well enough to ask, but i always wondered if she felt she had to go into radiology, or if she just happened to enjoy it best. but as functional as she was with only 1 hand, i doubt she'd have been able to complete a pathology residency, let alone a surgical one.

 

[sohsie]

I was covering someone on an advanced rotation at another hospital. I had just broken a bone in my left hand. I was not told that the PA had scheduled a vacation day and I would have to gross. I tried it for about a minute with just my right hand, gave up, and fortunately was able to persuade another resident on a CP rotation to come over and gross instead.

Grossing with one hand would be extremely difficult.