Research Residency in Pathology...

[SaltySqueegee]

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I know a number of institutions offer extensive research components to pathology residents that are interested in the academic pursuit. However, information about the formatting of the clinicals and the research time is a bit vague on the websites I've perused.

So, my question to the Studentdoctor forums is: What does a reasonable Pathology research residency look like? Detailed organization of the research and the residency time. The reason why I'm asking is I have already lined up a Post-doc experience, but it is at an institution that does not currently have a Pathology research residency in place; I'll be the first. So I'll have to come up with a proposal of sorts for the department chair.

In short, I have the funding for the research, I have the preliminary support of the department chair, but I need a detailed gameplan that would allow me to perform a significant amount of research, working towards a K award, hopefully some lone repayment awards, and residency.

Thoughts on research residency designs for Pathology? Detailed plans that you or others you know have followed? Is it feasible to even begin research in the first year, or should it wait until the second? 5, 6, 7 year residency?

Regards,

-Salty

 

[yaah]

An adequate residency would allow you to be board certified. Formal pathology residencies have a certain number of required rotations (i.e. X months of surgical pathology, X months of autopsy, X months of blood bank) although you can just do AP or just do CP. AP only, if I remember right, still requires 24 months of actual pathology rotations. The other 12 months can be elective (research). It doesn't really matter what order you do these things in. You could do all 24 months and then leave year 3 for just research. Or you can mix and match. So you have to figure out how to go about that. If there are certain rotations in your program that are lighter and would still leave you time for research, you can maybe bunch those together with electives and stretch out your time.

Bear in mind though that since you are taking up a residency spot, you are going to have to actually fill spots on the schedule and do the work. So your flexibility might be somewhat limited especially early on. It is good you have the dept chair in your corner, it would be wise to get support from multiple important individuals (program director, section heads) so that your unusual schedule doesn't create too many problems.

I am not sure what your options are for extending residency - if your program really wants you there they might be willing to extend your residency and give you an extra elective year, but more than likely you would need your own funding for that.

 

[olddog]

The American Board of Pathology will only allow six months max for research to count towards you months of qualification to sit for the boards, either AP only or AP/CP. The rest of the time must be in structured rotations.

 

[pathstudent]

Many academic medical centers offer combined residency-post doc programs, not just in pathology but in many specialties.

Most people I have seen typically do the residency work and then go into the lab. It might be possible to do clinical residency work and be in the lab with a CP residency.

 

[Enkidu]

I would just like to know which programs have structured research residencies in general. IM has a bunch of these programs, so it would seem that pathology would as well, but I can't really find information on them in general. I know of a program at MGH, but otherwise...

In the IM programs it's basically designed so that the resident does 2 years of IM, 3 years of post-doc, and maybe 1-2 years of fellowship (fellowship is also abbreviated somewhat, I think). This is all directed by the ABIM.

Why isn't there an analogous program supported by the american board of pathology?

 

[malchik]

The last thing you want is a bureaucracy like the ABP legislating research residencies. Among other arbitrary rules they'd probably come up with an additional fee.

I think it makes the most sense to do your clinical training first, then do research in combination with or after a fellowship. Then you write your K award and get a junior faculty job. The reason you can't find out about other programs than MGH is because the latter has a nice website and the others don't, not because they don't exist. Other programs that have structured research programs (which usually means they have come up with a cute acronym for it, but really just means they have FUNDING) are BWH, Penn, Stanford, UCSF, I think UCLA, Yale, Chicago. It is really just a departmental commitment to fund a postdoc.

 

[SaltySqueegee]

Thank you to all who replied. I think I'm getting a general picture of how I'm going to have to approach this. After some additional online search, I have a few observations:

1) None of the pathology research training programs I've seen offer a research component until at least 2.5 years of training are completed.

2) Most, if not all, combine it with a subspecialty and AP or CP only.

3) Points 1 and 2 may be due to the structure of NIH T, F, and K award mechanisms (none of which allow overlap with residency):

http://grants.nih.gov/training/FTAwardshp.htm
http://grants.nih.gov/training/kawardhp.htm

4) Even though the visual diagram looks like the T32 overlaps with residency, stipulations are in place that clinicals in residency be done before any significant % research component is attempted.

I was hoping that there could be some effort on level powers that be to support some integration between residency and research life. Yaah ---> You mentioned that some flexibility by the dept chair for scheduling rotations may allow for research time earlier on? Do you know of some examples where this has been done?

I guess I'll have to settle with fitting research in "somewhere."

 

[pathstudent]

You seem sirpisingly clueless about these things. Where are you at right niw

 

[SaltySqueegee]

You seem sirpisingly clueless about these things. Where are you at right niw

I'm at my computer. Sitting in my living room. Where are you? 🙄 And if I might also say, you have no tact and excel at generalizing.

...
...

I just finished my PhD, and am in my 3rd year of medicine. Spent the majority of my recent months adapting back to clerkship mode, and prior to that my time invested in grant applications was in the F30 mechanism. I haven't had the need to think much beyond that. At least until now. Because residency is coming up in a year and a half, I decided it was time to figure out the next few steps after clerkships and how I can fit a fundable research experience ontop of residency. I guess that makes me clueless. 👍

 

[KCShaw]

Terribly sirpising

I'm not familiar with anyone who has "recently" done what you're talking about in the way you seem to be talking about doing it. Most people I know have done a regular residency while fitting in odds & ends of research around it, and waiting to try to get major funding in time for post-residency dedicated research. You don't detail exactly what you mean by having funding for the research in your case, as in whether it would totally fund your position for X time. As far as the residency goes.. as long as you satisfy the ABP/ACGME requirements (and get enough training to pass the boards along the way), what your program allows you to do within or outside of that is a little malleable. How you fit research into or around residency and where funding comes from depending on what you're doing and how much of it you're doing is, I think, up to you and the program. I.e., do you take time off of residency, funded by research, or incorporate research into elective time, possibly work it in with mandatory rotations without somehow compromising training, etc.

My suggestion would be to look over the ABP requirements, taking particular note of time spent at the program and amount of specific rotational exposures required, then look at what you "have to" and "want to" do on the research side combined with the funding you have, and look for ways to make it all happen. Then present it to the department chair/PD and see what happens. Checking to see if the previously mentioned programs which apparently do this sort of thing regularly have any accessible real or example schedules might help, too.

I don't think this kind of approach is terribly common (I only know one or two people who incorporated a PhD in/around residency, and those who were already PhD's/serious into research all seem to have put off "serious" research until after residency, or did some basically on their own time). As one of my mentors liked to chant... TIMTOWTDI, a maniacally long and absurdly difficult to chant semi-readable acronym for "there is more than one way to do it." Yes, he was a little eccentric, but, welcome to pathology.

 

[BU Pathology]

Most academic pathology departments have opportunities for extensive research after you fulfill your board requirements. If they have a T32 grant, that provides a ready mechanism to pay for the training. If there is not a departmental T32, then your fellowship stipend is paid by the Principal Investigator where you will be doing your work. Speaking as a PI, having an MP\PhD pathology fellow working in the lab is a strong positive.

For my career, I did 2 years of straight AP training, then 2 years of immunopathology training paid by an NIH grant. I still attended conferences, and did 12 weekends of autopsies per year. By going to conferences and providing a modicum of service work, my training was still integrated into the Pathology Department. For boards (AP only) I did a minimal amount of studying, because the training had me prepared.

There is active discussion at the Chair level about establishing a more formal structure for research fellowships in Pathology, similar to how Internal Medicine works.

The Department of Pathology and Laboratory Medicine at Boston University does have a T32 training grant which would provide 2 years of research training. Additional information, and a shameless plug, may be found on our website:
http://www.bumc.bu.edu/busm-pathology/immunobiology-of-trauma-training-grant-t32-gm86308/

Good luck with your decision. For me, a research career in Pathology has been outstanding.

Daniel Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston University School of Medicine and Boston Medical Center

 

[olddog]

Again, I'd like to reiterate that the ABP will only allow six months of research to be used for qualification for the boards. According to the T32 grant of Dr. Remick's, no clinical work is allowed so no more than six months could be used to count towards ABP certification. One can not be paid as a resident and received outside grant support as residency is considered full time by CMS and to get further money from the government would be considered "double dipping". Programs which allow such time for research , to my knowledge, have it as a year or two years out for research, totally separate from residency training, and supported by grants or departmental funding. The resident then returns to complete the required months for ABP certification. Dr. Remick's completion of only two years of AP would no longer fly, but I do know of others who did it that way in the distant (sorry!) past

 

[SaltySqueegee]

Terribly sirpising

I'm not familiar with anyone who has "recently" done what you're talking about in the way you seem to be talking about doing it. Most people I know have done a regular residency while fitting in odds & ends of research around it, and waiting to try to get major funding in time for post-residency dedicated research. You don't detail exactly what you mean by having funding for the research in your case, as in whether it would totally fund your position for X time. As far as the residency goes.. as long as you satisfy the ABP/ACGME requirements (and get enough training to pass the boards along the way), what your program allows you to do within or outside of that is a little malleable. How you fit research into or around residency and where funding comes from depending on what you're doing and how much of it you're doing is, I think, up to you and the program. I.e., do you take time off of residency, funded by research, or incorporate research into elective time, possibly work it in with mandatory rotations without somehow compromising training, etc.

My suggestion would be to look over the ABP requirements, taking particular note of time spent at the program and amount of specific rotational exposures required, then look at what you "have to" and "want to" do on the research side combined with the funding you have, and look for ways to make it all happen. Then present it to the department chair/PD and see what happens. Checking to see if the previously mentioned programs which apparently do this sort of thing regularly have any accessible real or example schedules might help, too.

I don't think this kind of approach is terribly common (I only know one or two people who incorporated a PhD in/around residency, and those who were already PhD's/serious into research all seem to have put off "serious" research until after residency, or did some basically on their own time). As one of my mentors liked to chant... TIMTOWTDI, a maniacally long and absurdly difficult to chant semi-readable acronym for "there is more than one way to do it." Yes, he was a little eccentric, but, welcome to pathology.

I guess I'm just a bit antsy to get back to the lab. The PI I will be working with has a funded RO1 for 2012-2016, on an extension of a project I did for my PhD. I know I'm suppose to go elsewhere and spread my wings, but I really don't want to pass up the opportunity to test some of these hypotheses. I'd be kicking myself.

So to answer one of your questions, the research is funded in the sense that the PI has offered me a PostDoc to help service a portion of the grant (which I actually wrote a portion of), and is passing this portion of the lab's data for me to use as my preliminary data for career development awards, publications, etc. So, I'm a bit conflicted because a four year AP/CP residency would be from 2012-2016. The department chair is a strong supporter of research oriented pathologists, but because I'll be one of the first going through the residency with such a strong bent, I wanted to get a feel for what paths had already been blazed.

The portion (Aim2) of the grant that I would be responsible for servicing would begin around 2014-2016.

Thank you for the suggestions.

 

[SaltySqueegee]

Again, I'd like to reiterate that the ABP will only allow six months of research to be used for qualification for the boards. According to the T32 grant of Dr. Remick's, no clinical work is allowed so no more than six months could be used to count towards ABP certification. One can not be paid as a resident and received outside grant support as residency is considered full time by CMS and to get further money from the government would be considered "double dipping". Programs which allow such time for research , to my knowledge, have it as a year or two years out for research, totally separate from residency training, and supported by grants or departmental funding. The resident then returns to complete the required months for ABP certification. Dr. Remick's completion of only two years of AP would no longer fly, but I do know of others who did it that way in the distant (sorry!) past

Ouch. I guess I'm leaning towards fitting it into residency life. This research is too good to pass up. And if it means obtaining enough data for a K award. This is a tough one. I'm a bit fearful of cornering myself with an AP only or CP only type setup.

However, it might be reasonable to do AP only:
2012-2014: First two years AP material.
2015: Year 3 first half CP only type training (first six months could titrate up research with CP rotations; or so I've heard). Year 3 second half research only.
2016-->2018: Maybe arrange a post doc (75%) with clinical responsibilities (25%) and start writing grants like crazy.

Thank you all for your suggestions, and helping me logic through this transitional bridging process.

 

[pathstudent]

when you apply talk to the chairs and PDs about what type of set up they have for someone with your goals. I would try to fit my plan into the structure of the program rather than try to make the program fit my plan.

Also you could just go straight to research, if you aren't interested in spending a couple years looking at tubular adenomas, pap smears and running bowel.

 

[malchik]

Ouch. I guess I'm leaning towards fitting it into residency life. This research is too good to pass up. And if it means obtaining enough data for a K award. This is a tough one. I'm a bit fearful of cornering myself with an AP only or CP only type setup.

However, it might be reasonable to do AP only:
2012-2014: First two years AP material.
2015: Year 3 first half CP only type training (first six months could titrate up research with CP rotations; or so I've heard). Year 3 second half research only.
2016-->2018: Maybe arrange a post doc (75%) with clinical responsibilities (25%) and start writing grants like crazy.

Thank you all for your suggestions, and helping me logic through this transitional bridging process.

If you're this interested in research, do not be fearful of AP only or CP only. Even if you decide to bail on academics altogether when your brilliant hypotheses fail to pan out, it is still possible to get a private job with either AP or CP only, but you need a marketable skill, i.e. a fellowship. There's no way around it; if you want to practice pathology outside of doing occasional autopsies you're going to have to put in the training time, and your scenario above is not going to cut it. Even for boards eligibility, you have not accounted for 2.5 years of AP training there.

My recommendation: Maintain ties with the lab but don't spend significant time there, let a technician or grad student start the experiments with you advising. Meanwhile, put in 2.5 years of AP. Then start in the lab in earnest, building on the data the student/technician has been doing. At this time you can also do a nonboarded fellowship if you want with built in research time. In a total of 4 years you could have AP plus fellowship plus a K award if all goes well.

 

[KCShaw]

I don't see that ABP has any limit on how long it takes you to complete your training requirements to become qualified to take the boards, just on how long after -completing- the training requirements. Unless that issue is addressed somewhere (one would think it should be..), if your program allows you to "leave" then come back later, then you could go do research whenever and for as long as you like, then return to finish residency.

Given the explicit wording that only 6 months of residency training time (time going towards board qualification status) can be used on full-time research it sounds like you would otherwise technically be limited.. but in the world of residency this makes sense. It's not organized or paid for like academic jobs can be, with X% of clinical time and Y% of research time. Minus 6 months (most programs have internal requirements which eat up most of that "elective" time), you're on 100% clinical/service time and most programs can't afford to have you not do service work, regardless of the ACGME/ABP requirements.

 

[SaltySqueegee]

I don't see that ABP has any limit on how long it takes you to complete your training requirements to become qualified to take the boards, just on how long after -completing- the training requirements. Unless that issue is addressed somewhere (one would think it should be..), if your program allows you to "leave" then come back later, then you could go do research whenever and for as long as you like, then return to finish residency.

Given the explicit wording that only 6 months of residency training time (time going towards board qualification status) can be used on full-time research it sounds like you would otherwise technically be limited.. but in the world of residency this makes sense. It's not organized or paid for like academic jobs can be, with X% of clinical time and Y% of research time. Minus 6 months (most programs have internal requirements which eat up most of that "elective" time), you're on 100% clinical/service time and most programs can't afford to have you not do service work, regardless of the ACGME/ABP requirements.

I like the way you think. I think I have a number of options now to present to the department chair. See if he is amenable to any.

 

[SaltySqueegee]

If you're this interested in research, do not be fearful of AP only or CP only. Even if you decide to bail on academics altogether when your brilliant hypotheses fail to pan out, it is still possible to get a private job with either AP or CP only, but you need a marketable skill, i.e. a fellowship. There's no way around it; if you want to practice pathology outside of doing occasional autopsies you're going to have to put in the training time, and your scenario above is not going to cut it. Even for boards eligibility, you have not accounted for 2.5 years of AP training there.

My recommendation: Maintain ties with the lab but don't spend significant time there, let a technician or grad student start the experiments with you advising. Meanwhile, put in 2.5 years of AP. Then start in the lab in earnest, building on the data the student/technician has been doing. At this time you can also do a nonboarded fellowship if you want with built in research time. In a total of 4 years you could have AP plus fellowship plus a K award if all goes well.

Right. My understanding with the AP only is that you have to have 24 months of all AP, with 12 months of AP and/or CP electives, of which 6 months can be purely research.

"36 months of full-time training in an accredited APCP or AP program. Training must include at least 24 months of structured AP training. The remaining 12 months are flexible; and may include AP and/or CP. Training may include up to 6 months of research done during the pathology training program with the approval of the program director." - 2010 ABP booklet

Unless there are other stipulations I'm not aware of on the last 12 months?

Thank you all again. Excellent feedback.

 

[KCShaw]

Keep in mind, if you start talking about taking time off from residency, that for the most part programs need to have you during the typical resident year -- start of July to end of June. Otherwise they're likely to be down by a resident and may have problems filling their necessary service rotations. They also would need to plan ahead for the match to declare how many available positions they have; you coming and going would alter the number of residents in each year. Some mid to large programs do this from time to time, more commonly it seems to accommodate fellowship opportunities, but at least it may not be a foreign concept.

I suspect one of your problems won't be with the department chair whose responsibility includes bringing in research money, but with the PD (perhaps overseeing the chief resident) whose responsibility includes ensuring the resident service rotations are covered (in most residencies surg path and autopsy, +/- others, which could eat up most of the residents in the program at any given moment) when you start talking about doing 6 residency months of dedicated research/non service work. The chair can certainly pressure the PD into making it work, but realize there may be some political pushing, shoving, and grunting if only behind the scenes, if this is as unusual as it sounds at that department.